Health Matters Issue 9.3

H E A LT H Vol 9 I Issue 3 I Autumn 2013

INSIDE - Meet the Team - Melanoma - Generics - Self Care

MATTERS National Staff Magazine of the Health Service Executive

H E A LT H

ssue 3 I Autumn 2013

MATTERS

al Staff Magazine of the Health Service Executive

matters

HEALTH

Vol 4 I Issue 2 I Summer 2009

National Staff Newsletter of the Health Service Executive

The Benefits of Art Focus on ceramic artist National Staff Magazine of the Health Service Executive Diane McCormick

HEALTHMATTERS 40

53

Vol 5 I Issue 3 I Autumn 2009

98

107

Health Matters 1

Contents

53 A rts in health exhibition Dunamaise Arts Centre, Portlaoise.

54 Q uality assessment New resources launched.

56 N ews briefs 58 GUH PLASTIC SURGERY TEAM 60 REGIONAL NEWS 88 CO MMUNITY GAMES 89 H UMOUR 90 GARDE

NING

5 New hse directorate HSE board replaced.

30 N euroendocrine tumours New project to be developed.

7 Dr Steevens' Scholarship Skin cancer and melanoma research.

33 N ew surgery policies National Clinical Programme for Surgery launches two new policies.

11 generic medicines A Q&A to help prepare for change.

12 preferred drugs Second phase of initiative identifies two more preferred drugs.

15 Bike for life Get Ireland Active initiative to boost cyclist numbers.

17 Poetry day New anthology to be distributed in hospitals.

18 PER CENT FOR ART Meet Dungannon-based sculptor Diane McCormick.

22 irish architecture awards Phoenix Care Centre wins.

100 M ALAWI VOLUNTEERING Beaumont staff deliver cancer training.

35 Lymphoedema

103 PER CENT FOR ART Meet artist Mark Ryan.

36 C apital developments New builds in HSE South.

37 F inance Control Using HSE resources efficiently.

39 S elf-care for carers Alleviating stress.

40 C ounselling in primary care Service launched.

42 L etterkenny hospital Recovery plan on track following July's heavy flooding.

44 DATA PROTECTION Essential guidelines.

107 T rip to Lourdes 108 ME AND MY JOB 110 GREAT IRISH BAKE OFF Occupational therapist Bridget Harney.

112 M E AND MY JOB 113 A rt and health A professional development programme in the north-west.

114 LIFE STORIES Naas General Hospital.

115 FLU CAMPAIGN 117 PERSONAL FINANCE

24 Dementia education 27 Cancer Screening Three in ten not having smear test.

98 DIALYSIS ART PROJECT

34 H eart Attack Symptoms If in doubt, call 999.

41 C roke Park Agreement 20 Epilepsy The National Clinical Programme For Epilepsy: three years on.

93 B REASTFEEDING Support groups and personal experiences.

47 N ational Clinical Guidelines Patient safety initiative.

118 EMERGENCY SERVICES Heart attack in Cork.

49 N ews briefs 119 SPORTING PASSIONS

28 Beaumont oncology 29 Lung cancer symposiuM

52 RCPI Leadership course

120 Competitions

2 Health Matters

Welcome to the autumn edition of Health Matters, the national staff magazine of the HSE. In this issue we look at the HSE’s new campaign, Breastfeeding – A Good Start In Life, which is being launched for National Breastfeeding Week running from October 1st to 7th. Also, new mum Monica Devine describes the support she received from her local Breastfeeding Support Group.

We take a closer look at a brand new programme, Bike for Life, which aims to make cycling more accessible to everyone regardless of age, gender or ability. We also have a Q&A on generic medicines.

Elsewhere in the magazine, Beaumont Hospital staff members Clodagh McHugh and Paul Troy, who travelled to Malawi to deliver training in cancer care nursing, tell Health Matters about their experiences.

We meet the HSE team members of the Plastic Surgery Procedure Unit at Galway University Hospitals. Since opening last year the unit has reduced HSE West waiting list times for procedures such as soft tissue and digital nerve repairs, laser surgery and surgery on benign and malignant skin lesions.

We hope you find this issue’s mix of features, interviews, news and updates of interest.

For more regular updates, check out our staff intranet site http://hsenet.hse.ie or the HSE website – hse.ie

Sites we like...

www.hse.ie/generics

www.hse.ie/yourmedicines

Stephen McGrath – Editor Head of Internal Communications

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

www.breastfeeding.ie

Did you know?

• In its first year of operation, the Plastic Surgery Procedure Unit at Galway University Hospitals attended to over 1,600 patients.

• The Health (Pricing and Supply of Medical Goods) Act 2013 allows pharmacists to substitute generic versions of some prescribed medicines. www.getirelandactive.ie • Malawi is among the poorest countries worldwide – it ranks 170 out of 182 on the UN human development index scale.

• In Ireland there are currently over 41,000 people living with dementia.

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

Value through Innovation

Even after a century of experience, we remain intensely curious.

For the sake of future generations.

Boehringer Ingelheim has always remained true to its character as an independent family-owned company.

Our vision drives us forward. It helps to foster value through innovation in our company and to look to the future with constantly renewed commitment and ambition. Today, we operate globally with 142 affiliated companies in 50 countries. With more than 41,500 employees worldwide and a track record developed over 125 years, we are dedicated to improving the outlook for healthier lives. www.boehringer-ingelheim.ie

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Health Matters 5

Reform

HSE Board Replaced by New HSE Directorate The HSE board was replaced by a new HSE Directorate in July. The development is a key step in relation to Future Health, the Government’s health reform programme for the Irish health service. The new HSE Directorate is a precursor to the creation of a healthcare agency.

M

r Tony O’Brien was formally appointed by the Minister for Health, James Reilly TD as Director General of the HSE and Chairman of the Directorate. A number of directors were appointed by Minister Reilly to the Directorate.

These were: Laverne McGuinness, Chief Operations Officer and Deputy Director General; Tom Byrne, Chief Financial Officer; John Hennessy, Director, Primary Care; Ian Carter, Director, Acute Hospitals; Pat Healy, Director, Social Care; Stephen Mulvany, Director, Mental Health; and Stephanie O’Keeffe, Director, Health and Wellbeing.

The Integrated Services Directorate (ISD) of the HSE – which had responsibility for the delivery of all health and personal social services across the country including hospital, primary, community and continuing care services – ceased to exist, and responsibility for service areas within ISD transferred to the newly-established service divisions of Primary Care, Acute Hospitals, Mental Health and Social Care.

In this new structure, the five new national directors have begun the process of moving

HSE Directorate and Leadership team

National Lead Transformation & Change L. Kearns

National Director Clinical Programmes A. Carroll

National Director Cancer Control Programme S. O'Reilly

towards a commissioning environment in each of their respective areas of responsibility. The chief operations officer will now have primary responsibility for overall performance management across the entire service, for service planning, and for ensuring that services are delivered in an integrated and co-ordinated way across all areas.

In parallel with these changes, four regional directors for performance and integration (RDPIs) have been appointed. The four new RDPIs are David Walsh, Dublin Mid Leinster; Angela Fitzgerald, Dublin North East; Gerry O’Dwyer, South and Gerry O’Neill, West.

The RDPIs will play a key role in the performance and integration of services at regional level, and ultimately will act as commissioning/contract managers within the healthcare agency. They have also, on an interim basis, taken on the full range of delegated operational responsibilities formerly held by the regional directors for operations (RDOs), reporting directly to the relevant national director for individual services. Staff who reported to the RDOs are now reporting to the RDPIs unless notified otherwise.

HSE Directorate

In a message to HSE staff the Director General, Tony O’Brien said he was deeply conscious of the many demands and pressures faced by staff on a daily basis across the service.

“I am equally conscious of the strong desire and commitment of so many people throughout the health service to improve the care we provide to those who place their trust in us at the most vulnerable times of their lives. It is this dedication and professionalism that will sustain us in the months and years ahead as we make the changes that are needed to build a health service that we can all be proud of – one that enables, values and empowers staff to provide the care that our patients and clients need.”

He said he hoped the establishment of the Health Services Directorate would provide direction and support to staff during a time when the health system was being reformed in the interests of those it served.

Mr O’Brien has accepted a five-year contract as director general of the health service. He said he very much looked forward to working with colleagues in the years ahead.

National Director Internal Audit M. Flynn

Director General T. O'Brien

COO/Deputy General L. McGuinness

CFO T. Byrne

National Director Quality & Patient Safety P. Crowley

National Director Acute Services I. Carter

National Director Primary Care J. Hennessy

National Director HR B. O'Brien

National Director Social Care P. Healy

National Director Health & Well Being S. O'Keeffe

National Director Shared Services L. Woods

National Director Mental Health S. Mulvany

National Director Communications P. Connors

National Director Children and Families G. Jeyes

Health Matters 7

Dr Steevens’ Scholarship

Melanoma and Surgical Oncology Fellowship Dr Kieran Power, Specialist Registrar in Plastic and Reconstructive Surgery, was awarded the Dr Richard Steevens’ Scholarship in order to complete a melanoma and surgical oncology fellowship at the Melanoma Institute Australia.

I

am spending the final year of my specialist training in plastic and reconstructive surgery doing a fellowship in melanoma and surgical oncology at the Melanoma Institute Australia. This fantastic opportunity was made possible by the support of the Dr Richard Steevens’ Scholarship, for which I am very grateful.

Melanoma is the most serious form of skin cancer. Fortunately, melanoma detected early can be treated easily by surgery. Advanced disease has a poor prognosis, affecting both young and old patients and there is a frustrating lack of effective treatments.

High levels of UV exposure in Australia The population of Australia is largely of Caucasian origin with an Anglo-Celtic skin type. Indeed, many are of Irish descent.

This fair skin type was never intended for the high levels of UV exposure in Australia.

That coupled with an outdoor lifestyle and beach culture has resulted in Australia reporting the highest rates of melanoma and other skin cancers in the world. One in 25 Australians will develop a melanoma during their life-time. Melanoma is very much Australia’s 'national cancer' and they are leading the world in the management of this difficult disease.

Although not to the same extent as Australia, melanoma represents a significant public health issue for Ireland. The incidence of melanoma in Ireland is increasing at a rate of 5 per cent per year. In 2008, there were 815 invasive and 385 in situ cases of melanoma. Ireland has the fourthhighest rate in Europe for females and eighth-highest for males. It accounts for 113 deaths per year. The National Cancer Control Programme (NCCP) has identified skin cancer and melanoma as an area in

“One in 25 Australians will develop a melanoma during their life-time.

Melanoma is very much Australia’s 'national cancer' and they are leading the world in the management of this difficult disease.” need of further development. The skills and experience that I am gaining at this centre of excellence will enable me to deliver improved skin cancer services to Irish patients.

Melanoma Research Melanoma is currently entering a new era with the development of targeted therapies and immunotherapies for advanced disease. The Melanoma Institute Australia is the world’s largest melanoma research and treatment centre. Professor John Thompson is the executive director of the unit, which has an internationally recognised faculty. It is located at the Poche Centre in north Sydney in a state-of-the-art facility built with a generous donation of Aus$40 million by philanthropist Greg Poche. It is a not-for-profit organisation dedicated to preventing and curing melanoma through innovative world-class research, treatment and education programmes. The institute has over 70 staff including surgeons, dermatologists, oncologists, radiation

oncologists, nurse specialists, clinical trials staff and researchers.

The institute maintains the largest patent database and integrated tumour bank in the world and is conducting several research projects. They are undertaking exciting work looking into the genome of melanoma to enable individualised targeted chemotherapy for advanced disease. They are also conducting many multi-centre international clinical trials.

The institute is recognised as one of the most active surgical research centers of any type in Australasia, if not the world.

Current trials are assessing the value of surgery, radiotherapy, chemotherapy and immunotherapy treatments. This fellowship has enabled me to engage in this research and foster links for potential collaborations between Ireland and the Melanoma Institute Australia. This would have obvious benefits for Ireland.

World Experts The Melanoma Institute Australia attracts a large volume of complex cases. As a surgical specialist I spend much of my time attached to Professor John Thompson and Associate Professor Jonathan Stretch. Professor Thompson is a surgical oncologist who specialises in surgery for advanced disease such as lymphadenectomies including ilioinguinal dissections, resections for distant metastases and isolated limb infusion. Associate Professor Stretch is a plastic surgeon who specialises in facial melanoma and skin cancer. Surgical treatment of facial skin cancers can result in significant deformity and disfigurement.

Plastic surgeons are trained in a variety of reconstructive techniques, which enable them to achieve the best aesthetic and functional outcomes without compromising

8 Health Matters

Dr Steevens’ Scholarship

+ Dr Kieran Power at the Melanoma Institute Australia.

on clearance of the tumour.

I also had opportunities to gain exposure to the other disciplines within the faculty (head and neck surgery, dermatology, medical oncology, radiation oncology and nuclear medicine). I have become skilled in dermoscopy, which is a valuable diagnostic tool for the screening of pigmented lesions.

I have experienced the value of in-vivo confocal microscopy for diagnosis and preoperative mapping of problematic in-situ melanomas. There is an excellent weekly multi-disciplinary meeting where the entire faculty discuss complex cases. In addition there are regular research meetings with visiting international experts presenting their work in melanoma.

A key element of melanoma care is public awareness campaigns to promote disease prevention and early detection.

The Melanoma Institute Australia is heavily involved in public awareness and fundraising for research. It is impressive

how everyone in the organisation participates in this. During my time I have spent a Saturday on Bondi Beach providing sun protection and skin check advice. We also participated in the Melanoma March (family fun-run). There is also an active patient group involved in fund-raising and public-awareness. Such strategies could easily be adopted in Ireland.

Settling Into Sydney In August 2012, my wife and our then five month-old boy set off for Sydney with just a few suitcases. The first week involved finding accommodation, signing up for utilities, bank account, mobile phone, internet connection, medical registration and so on. Fortunately we were soon set up in our new home without too much difficulty. The chance to spend a year in Sydney has been a fantastic experience for us as a family. Sydney is a beautiful, vibrant city surrounded by amazing harbours and beaches. The people are very

friendly and we found it easy to settle in.

There is a strong Irish influence here, with lots of cultural similarities. We will certainly miss the sunny climate and outdoor lifestyle.

There is a lot to see and do, from exploring the city and surrounding beaches to visiting the Blue Mountains or the Hunter Valley wine district.

Overall, the opportunity to work and live in Sydney has been a fantastic experience.

It has been a privilege to work with some of the world experts in melanoma and skin cancer. The working relationships that I have established and the experience gained will be invaluable throughout my career.

I believe this fellowship has provided me with the necessary training to take a lead role in the development of melanoma and skin cancer services in Ireland. In the spirit of the Dr Richard Steevens scholarship, it is my ambition to return to Ireland and use my expertise in melanoma for the benefit of future patients.

an is ir h ny pa m co

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Health Matters 11

Medication

Generic Medicines:

Just as effective and just as safe New legislation being implemented this year means that we’ll be using more generic medicines in Ireland.

This Q+A on generic medicines will help healthcare workers and patients learn more about the changes that are coming.

What are generic medicines?

Generic medicines are safe copies of wellknown medicines, and usually cost less.

The generic medicine may look different and there will be a different name on the label. However, it will contain the same active ingredient as the original medicine, is just as safe and just as effective.

What is the new law?

The Health (Pricing and Supply of Medical Goods) Act 2013 allows pharmacists to substitute generic versions of some prescribed medicines. This law is being introduced in phases, product by product, over the coming months and beyond.

This law will save money for people paying for medicines, the health system and the taxpayer.

Previously, if a brand name medicine was prescribed the pharmacist had to dispense this brand. Substitution will only be allowed if the alternative version has been included on an Interchangeable List published by the Irish Medicines Board.

What drugs are affected first?

The legislation will apply first to certain types of medicines such as those for high cholesterol, high blood pressure, acid reflux and stomach ulcers, as these medicines are widely used and result in significant costs to the State. The first medicine to be affected is atorvastatin, which is used to control cholesterol. You can search the Irish Medicines Board list of Interchangeable Medicines on their website www.imb.ie.

How will it work for patients?

When you bring your prescription for one of the affected medicines to the pharmacist, they may offer you a less expensive medicine than the one on your prescription.

Your pharmacist will assure you that it is just

as safe and effective as the product listed on your prescription.

Reference Pricing A new pricing system is also being introduced later this year which means that the HSE will set one price, called the reference price, that it will pay for each group of interchangeable medicines.

Reference pricing is, like substitution, being introduced in phases, so not all people or all medicines will be affected at once.

How will reference pricing affect patients?

From November on, reference pricing for atorvastatin will mean that no matter which version or brand of atorvastatin is dispensed, the HSE will only cover the cost of the agreed reference price for that group of products.

So patients will have two options: • They can choose the less expensive medicine and save money. If they are using one of the drugs schemes (e.g. Medical Card, Drugs Payment Scheme, etc), the HSE will pay the pharmacy the full reference price for this group of medicines.

• They can choose a higher priced medicine, and pay the difference between the reference price and the retail price.

• Please note that the HSE will use the reference price of the medicine group to calculate a patient or family’s monthly Drugs Payment Scheme costs.

What happens if patients need to receive a particular brand of medicine for medical reasons?

The doctor or prescriber will be able to state on the prescription that that particular brand is to be provided. They will write 'do not substitute' beside that item on the prescription and the pharmacist will dispense the brand listed. In this situation, a patient will not have to pay any extra for their medicine.

Do other countries use reference pricing and generic substitution?

Yes. Many European member states have systems of reference pricing and generic substitution. Similar systems are also in operation in Canada, Australia and the United States.

How will this affect me?

Patients who will be affected by this change in the law and the pricing system will be informed by their GP, by their pharmacist, and through information supplied closer to the time by the HSE. For more information go to www.hse.ie/ generics.

SAME MEDICINE, DIFFERENT NAME.

12 Health Matters

Medicines Management Programme

Preferred Drugs: The Right Choice, Right Now Preferred drugs in the angiotensin-converting enzyme ACE inhibitor and angiotensin II receptor blocker (ARBs) categories have now been identified as part of the latest phase of the Preferred Drugs Initiative, writes Professor Michael Barry, Clinical Lead for the Medicines Management Programme.

T

he HSE’s Medicines Management Programme (MMP) has identified two new preferred drugs as part of the second phase of the Preferred Drugs Initiative. The selection of a preferred ACE inhibitor and ARB is designed to support prescribers in choosing a medicine of proven safety and efficacy in the management of patients with cardiovascular conditions such as hypertension and heart failure. In selecting a preferred ACE inhibitor and ARB the MMP aims to enhance the quality of prescribing and provide value for money.

The preferred ACE inhibitor is Ramipril and the preferred Angiotensin II Receptor Blocker (ARB) is Candesartan.

The HSE currently spends in excess of a40 million a year on ACE inhibitors and ARBs under the General Medical Services (GMS) scheme, with ARBs accounting for approximately a25m of this expenditure.

Previously, the first tranche of preferred drugs recommended were for (i) proton pump inhibitors, where the preferred drug is lansoprazole and (ii) in the area of statins, where the preferred drug is simvastatin.

Selection Process A rigorous selection process was undertaken to identify the preferred ACE inhibitor and ARB, which focused on areas such as value for money, safety and efficacy and patient factors such as drug tolerance and the risk of adverse effects. A consultation process was also carried out with submissions being invited from interested stakeholders, while Irish and international clinical guidelines were also considered. Expert opinion was also taken into account. In addition, current prescribing patterns for ACE inhibitors

and ARBs, under the GMS scheme, were examined as part of the selection process for identifying the preferred drugs in each of the two drug groups.

New Patients The MMP is recommending that prescribers consider prescribing these two new preferred drugs for patients who require ACE or ARB therapy. However, these drugs are not suitable for all patients – for example pregnant women, children and patients with congenital cardiac conditions.

“The preferred ACE inhibitor is Ramipril and the preferred Angiotensin II Receptor Blocker (ARB) is Candesartan.”

For further information visit www.hse.ie/ yourmedicines.

Dosage Guidelines Ramipril Ramipril could be considered to have a favourable licensed indication as it includes not only hypertension and heart failure but cardiovascular prevention, reducing cardiovascular morbidity and mortality in patients with atherothrombotic cardiovascular disease or diabetes mellitus with at least one risk factor. It is also licensed for renal disease due to glomerular diabetic and non-diabetic nephropathy. Ramipril is taken once daily and in patients with hypertension the recommended starting dose is 2.5mg daily, which may be gradually increased to the maximum 10mg daily dose depending on the blood pressure response. For patients with heart failure who are stabilised on a diuretic, the recommended starting dose is 1.25mg once daily. This may be gradually titrated upwards and the maximum dose is 10mg once daily. The dose of ramipril will be influenced by renal function.

Candesartan The recommended initial dose and the usual maintenance dose for patients with hypertension is 8mg once daily. This may be increased to 16mg daily if required as therapy is adjusted to blood pressure response. The maximum dose is 32mg per day. For patients with heart failure the recommended starting dose is 4mg once daily. This may be uptitrated to the maximum dose of 32mg per day or the maximum tolerated dose. The dose of candesartan will be influenced by renal function.

Cycle SuperStore, in business for more than 30 years, has grown from humble beginnings to become Ireland’s biggest bicycle store, located just 14km from Dublin city centre.

We pride ourselves on the quality and number of brands we carry, the knowledge we have amassed and are waiting to

share with every customer, and the passionate cyclists who make-up our staff. We have experts across all areas of cycling, from competitive Road and MTB cycling, to the leisure cyclist and everything in between. It is this level of expertise that strongly marks us out against our competitors.

All HSE staff will receive 10% RRP off their bike for the month of September.

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Health Matters 15

Get Ireland Active

Bike for Life project to give cyclists confidence on the road The HSE, in partnership with Cycling Ireland, has created a brand new programme: Bike for Life aims to make cycling more accessible to everyone, regardless of age, gender or ability.

+ Caroline Ryan (world medallist track cycling), Colm Casey (HSE Physical Activity Coordinator), Heather Boyle (Development Officer Cycling Ireland), Geoff Liffey (CEO Cycling Ireland), Dr Nazih Eldin (HSE Health Promotion), Rachel Ormond (Cycling Ireland) and Matt Cooper (Today FM ambassador for the programme).

S

ponsored by the HSE’s Get Ireland Active initiative, the focus of the new ten-week programme is on instilling confidence in cyclists by teaching them skills for all situations, while having a major focus on fun and social interaction. Through meet and spin groups, led by a qualified cycling coach, cyclists will be brought through topics like nutrition and goal setting, along with learning skills like group cycling on the road and bike maintenance.

Nazih Eldin, Head of Health Promotion in the HSE DNE, said: “Cycling is a nonweight bearing activity that is easy on your joints, making it an inclusive health

enhancing physical activity.”

According to Colm Casey, HSE Physical Activity Co-ordinator, “Bike for Life will be instrumental in developing a strong cycling culture in Ireland, where we are experiencing a cycling boom. While it is commonly thought that once you learn to ride a bike you will never forget it, the reality is that bike handling skills take a bit of practice to perfect.

“Bike for Life is a ten-week programme that will equip cyclists with the skills necessary for the type of cycling they want to do, while creating 'Meet and Train' groups nationwide. The skills and

“Cycling is a non-weight bearing activity that is easy on your joints, making it an inclusive health enhancing physical activity.”

16 Health Matters

Get Ireland Active “Bike for Life is the perfect transition into cycling for everyone, whether they have just bought their bike, or like me have come from another sport.

I think Bike for Life will be particularly appealing to women, given the nature of the meet and spin groups.” knowledge gained in this programme will make the world of cycling more accessible to everyone, with the main focus being on learning skills, enjoying the bike and meeting new like-minded people.”

Bike for Life is a programme offered at three levels and consisting of ten to-12 weekly sessions. Each week will offer some skill or knowledge development, with an emphasis on actual riding. The aim is to improve the confidence and competence of riders primarily in a road environment, although it can be delivered in other settings.

Ambassador for the programme Matt Cooper, from Today FM, said that “Bike for Life should transform how people view cycling. It’s a new programme that connects people who want to improve their cycling, no matter what level they are at, and I am really happy to endorse it.”

International cyclist Caroline Ryan also backed the programme. “I came into cycling late, from a rowing background, and fell in love with the bike,” she said.

“Bike for Life is the perfect transition into cycling for everyone, whether they have just bought their bike, or like me have come from another sport. I think Bike for Life will be particularly appealing to women, given the nature of the meet and spin groups.”

For more information see www.getirelandactive.ie or contact heather@cyclingireland.ie.

+ Ambassadors for the programme Matt Cooper of Today FM with international cyclist Caroline Ryan.

What will cyclists gain from the programme?

• Bike skills, confidence on the road, and may be inspired to take cycling to new horizons.

• Cycling can significantly improve the health of participants. Weight management, coronary heart disease, some forms of cancer and mental health are among the conditions that can be mitigated by regular cycling.

• Rehabilitation and prevention of injury, because of its low impact form of exercise.

• An easy way to fit exercise into the daily regime because it is also a form of transport.

Bike for Life Categories: where would you fit in?

Bike for Life has been developed around three levels based on the abilities, competencies and goals of the individual rider and group of riders taking part in the programme. For the purposes of the Bike for Life programme there are three categories.

Level One (Beginner): • Rider has a basic or low level of fitness.

• Riding is at a basic level of competence and confidence in a traffic environment is low.

• Would like to be able to cycle ten to 20km.

Level Two (Intermediate): • Rider has basic level of fitness, but does not cycle regularly.

• Rider is confident on quiet streets; uses his/her bike on occasional basis.

• Wary about making journeys involving busier traffic.

• Would like to be able to cycle 40 to 60km.

Level Three (Advanced): • Rider has a good level of fitness and can exercise for 90 minutes comfortably.

• Rider is relatively confident in traffic and has acquired skills through training or experience in basic road manoeuvres.

• Would like to be able to cycle 75 to 150km.

The Irish Sports Council, which also supports Bike for Life through its Women in Sport initiative, recently confirmed cycling as one of the three accessible means of physical activity, along with walking and swimming. To register your interest in activity in your area, contact heather@cyclingireland.ie.

Health Matters 17

Poetry Day

A Gathering Place Menu of Poems takes the form of a short anthology of poetry which is distributed annually to health service users in a range of healthcare settings in partnership with Poetry Ireland. Devised by the Waterford Healing Arts Trust in celebration of Poetry Ireland’s All Ireland Poetry Day, it was first introduced to patients in Waterford Regional Hospital in 2009.

T

o coincide with All Ireland Poetry Day on Thursday October 3rd, a unique poetry collection – A Menu of Poems – will be distributed on a number of hospital wards, in waiting rooms, day care centres and other health settings for patients, visitors and staff to enjoy. The poems are specially selected for healthcare contexts and the menu is designed as an A4 folded pamphlet, made available as a PDF for selfprinting and distribution at each location.

Menu of Poems fits within the broader aims of Arts + Health: to make accessible art and art making in healthcare contexts as a basis to make meaning; to practise creativity and enrich the imagination despite illness, infirmity or health status; and to enhance healthcare settings as culturally rich environments for all.

According to Caroline Peppard, Senior Health Promotion Officer, “the role and value of the arts in the promotion of positive health and wellbeing is widely acknowledged. This initiative is particularly important in that it makes poetry as an art form very accessible for all age groups and has the potential to influence patient experience and best healthcare practice.”

Menu of Poems has grown from year to year and this year’s offering, A Gathering Place, has been edited by the Sligobased poet and visual artist Alice Lyons, with support from an advisory group of healthcare professionals and service users and was coordinated by the Arts Initiative in Mental Health, a programme of Mental Health Services Sligo/Leitrim. With gatherings of all kinds taking place across the island of Ireland in 2013, it is fitting that this year’s menu gathers together poetry that deals with kinship, travel, gathering of one’s self and a poem about a table – what better gathering place?

A patient in Galway University Hospital said: “I enjoyed all of them, each in its own ‘frame’ of a smile, a tear, a longing and many

+ A Moment in Time – Menu of Poems 2011 at Skibbereen Hospital. Patients pictured with Pat O’Mahony, Matron (since retired) and artist Sean O’Laoghaire. Photography: Miranda Daly.

more feelings. I hope each poet continues to fill our days with wonder and smiles.”

Menu of Poems is a joint initiative between Arts for Health Partnership Programme West Cork, Waterford Healing Arts Trust, Galway University Hospitals Arts Trust, West Cork Mental Health Services, Naas General Hospital Arts Committee, Arts in Health at Cork University Hospital and the Arts Initiative in Mental Health. On All Ireland Poetry Day in 2011, the project reached an estimated 7,000 patients, staff and visitors and we invite those working in healthcare environments to print copies for meal trays, staff canteens or wherever people gather – you may even organise your own poetry reading event of these and other well-loved poems. Most of all, we hope that you enjoy the poems selected!

To download a copy visit www.artsandhealth.ie.

Email your comments to menu. of.poems.2013@gmail.com.

Menu of Poems is a project of Arts and Health Co-ordinators Ireland and is kindly supported by Poetry Ireland and Health Promotion, HSE.

To Make A Table To make a table you need wood to make the wood you need a tree To make the tree you need a seed to make the seed you need fruit to make the fruit you need a flower to make a table you need a flower.

By Gianni Rodari, translated by Maurice Scully. From Five Freedoms of Movement (Galloping Dog Press, 1987 and Etruscan Books, 2001).

18 Health Matters

PER CENT FOR ART

Living art Diane McCormick has created many pieces of art for Irish hospitals over the past 10 years. She speaks to Sarah Kiely about the challenges and rewards of producing art for healthcare units.

D

ungannon-based Diane McCormick is a prolific artist whose work is a familiar element within many healthcare settings in Ireland.She attended the University of Ulster at Belfast (formerly Belfast Art College), where she studied ceramics. Having graduated in 1988, McCormick began creating art to be sold in shops and in galleries when she was asked to create a piece for the new Antrim Hospital in 1994. She has been commissioned to create pieces for hospitals and healthcare units ever since.

Doing so requires a particular approach on the part of the artist, as she explains.

"I'm going in with a mind to talk to patients and staff to try and speak to them about what goes on within the unit. Each commission is totally different. You couldn't transfer one commission to another site."

A Good Day For Drying In 2011, McCormick was commissioned by the HSE to create a piece of artwork for the residential unit at St Joseph's Hospital. For this piece, McCormick drew inspiration from the local area.

"For 'A Good Day For Drying', they saw a piece they really liked, which was an alphabet washing line. It was a game for children in another hospital. Because it was an older person's unit I thought it would be quite funny to have a clothes line. When I drove up to the unit, there was a football field with some seagulls on it so that brought things in – like I had a football kit with seagulls on top of it, and a small dog pulling somebody's jumper."

She also carried out research into the history of the locality. "Within the clothes themselves, they had bits of history of the area. For example, there's a tea towel with a picture of a castle and a wee pair of pants with fish on them; some things that were not so obvious until you stand and look at it." McCormick ensures that the piece remains fresh, with complex patterns that offer a new discovery at every viewing. "I would like something that you don't get straight away; you have to stand [and look

at]. If you're going past it every day, like lots of staff and patients and families are, you get something different every time."

Chain of Charms McCormick has had a relationship with Beaumont Hospital for years, creating many pieces for the north Dublin facility.

In 2012, Beaumont chose her design for 'Chain of Charms' to be included in their oncology unit. The concept for the piece

was to create a charm bracelet and "within that chain of charms, the idea was to have a bracelet running along the wall and they decide what they want to hang below it."

She got many of the images for the charm bracelet from patients recounting their stories and inspiring designs. "Different patients gave me an idea of what kept them going through the unit, what made them stronger or what they wanted to put on – maybe to remember somebody. So it

Health Matters 19

PER CENT FOR ART was really personal, that piece, both to the staff and to the patients going through."As with all her pieces, McCormick placed a lot of emphasis on creating art for the people who would see it every day. "Some of the people were going to be in and out for so many days, and some of them were going through a lot of pain – so their piece was a lucky charm bracelet."

Health Benefits McCormick is an avid supporter of the Per Cent For Art Scheme. The work is also uniquely suited to her artistic process. "I always like somebody to give me a starting point. Then I can do a bit of research, dig into what's in the area, a bit of history and find out what the people in the unit are going to be looking at, what they're doing every day."

One of her main considerations is the viewer's response to the art. "I don't think there's any point in putting up a piece of art that somebody is just going to walk past and ignore. I like that connection with people." McCormick feels this is especially important because the piece will be viewed by patients, family and staff each day and not by her. "In a big sense, I feel like it belongs to the people in the unit."

Another key consideration is the setting of the piece. "For cancer care units, they have to be uplifting and put some humour in it. It's a sad time for people, but they don't always want to be reminded of it.

They want something that will cheer them up and remind them of the good things they have in life. The best thing is when you get good feedback."

McCormick understands the importance of art in hospitals and healthcare units as championed by the Per Cent For Art Scheme, because she believes in the benefits art has on our health and recovery.

"There have been so many studies about art and how it can help reduce blood pressure and anxiety. Good art in hospitals fulfills many roles: first of all it could be a distraction for people sitting in a waiting room, and then if you have an environment that's looked after it gives the impression that if people care about their environment they care about you – and it's true, too.

People do care more when the place is clean and tidy and it's well presented and people will feel better going in."

McCormick has just one suggestion on how the scheme can go a step further in

“If you're going past it everyday, like lots of staff and patients and families are, you get something different every time.” obvious. Some are simply practical, such as viewing the space to see what it allows for and how the piece is going to be designed, constructed and installed.

Another consideration is the atmosphere of the setting and how the piece can act within the space. "I think you have to be very sensitive in any hospital situation you're in: think about the people coming in and what they're going through." McCormick has created art for many different hospitals and units that provide a varied range of services, each of which requires a unique perspective. "A lot of the issues with a mental health unit are practical," she says.

"You don't want people climbing on it, you don't want sharp edges, you don't want something that can be broken that they can cut themselves with because these are very vulnerable people and they can do quite a lot if they have a psychosis or self harm.

You have to be aware of practical issues like that, especially when you're working with ceramics which can be broken." But McCormick is quick to find solutions to these challenges. "There are ways around that: you can embed things in the wall and maybe have them out of reach, up high."

incorporating art into hospitals. "If they bring artists in at the building stage, it would integrate better, create a better looking building and make people feel more comfortable."

Practical Considerations Not all considerations in creating an art piece for a healthcare environment are

Work in Progress McCormick's next commission is for the mental health unit at Cherry Orchard Hospital in Ballyfermot. "I'm actually taking a ceramic design and making it into a graphic work that can go on wallpaper. I'm doing a lot of design work which is quite new to me: we're designing wallpaper and doors, and we're working on a big design for an outside wall at the minute." Once completed, it will contribute significantly to the caring environment at Cherry Orchard: another healthcare setting benefitting from Diane McCormick's work under the Per Cent For Art scheme.

20 Health Matters

Epilepsy

National Clinical Programme for Epilepsy: Three Years On The National Clinical Programme for Epilepsy was established just over three years ago under the direction of the Clinical Strategy and Programmes Directorate. The programme is focused on improving the access, quality and value of epilepsy care for patients in Ireland.

E

pilepsy is the commonest neurological disorder among young people in the world, and is characterised by recurrent seizures. The condition affects around 30,000 to 40,000 people in Ireland. This means that about one in 130 people has epilepsy. Epilepsy usually begins during childhood, although it can start at any age. There are upwards of 5,000 hospital admissions a year, with average lengths of stay of five to 10 days.

Standardisation of Care The National Clinical Programme for Epilepsy (NECP) is developing a comprehensive care programme that delivers care from cradle to grave for people with epilepsy. One of the first steps undertaken was to introduce a standardised approach to how epilepsy services were delivered throughout the country.

The introduction of standard operating procedures and key performance indicators ensure that patients receive the same level of service no matter where in the country they are accessing epilepsy services.

The standardised operating procedures cover everything from primary care referral to specific integrated pathways for managing seizures in the emergency room. Consultant Neurologist and Clinical Lead for the Epilepsy Programme, Dr Colin Doherty, explains: ”International studies have shown that variability of care is a key problem; probably our major achievement is to design a set of standard operating procedures. Two

WORKING GROUP Clinical Lead: Dr Colin Doherty Nurse Lead: Máire White Work Force Planning: Mark White Principal Physicist: Mary Fitzsimons Programme Manager: Roisin Breen

+ Mary Fitzsimons, Principal Physicist at Beaumont Hospital Programme, at work.

and half days a week I meet with the project team consisting of a lead nurse, project manager and a workforce manager and we have designed a series of programmatic interventions to reduce variability of care for epilepsy nationally.”

Regional Epilepsy Centres The National Clinical Progarmme for Epilepsy has developed a model of care for the management of epilepsy care as close to the patients as possible. The programme aims to regionalise epilepsy care at four adult epilpesy centres, regionally based across Ireland, and to have a paediatric centre in both Dublin and Cork. The four adult centres are based in Beaumont, St James's, Cork and Galway/Sligo.

Advanced Nurse Practioners Central to the establishment of the regional

epilepsy centres is the development of a team of expert epilepsy nurses trained to advanced nurse practioner (ANP) level. The recruitment of this cohort of epilepsy nurse specialists is critical to the delivery of chronic disease management for epilepsy at the hospital interface and in the community.

These nurses have the capability to prescribe medicines and provide a new tier of expertise, freeing up neurologists and epileptologists to concentrate on diagnosis, diagnostic difficulty and most refractory epilepsy care.

According to the Workforce Planner for the Epilepsy Programme, Mark White, this model of care is exclusive to Ireland. “It’s a unique model, it frees up clinical consultant time for consultations to review the most severe or uncontrolled cases of people with epilepsy,” he says. “Most service users have a long term relationship with the service for updates

Health Matters 21

Epilepsy and reviews of medication and we figured out that nurses could do this.” Dr Doherty concurs: “This has been a revelation for me.

I find I come in and everything is taken care of. I’m getting the top 20 per cent of difficult cases – that I should be getting – that’s what I should be spending my time on.”

The good news is that the majority of these nurses have been appointed; full quota exists in Dublin, Galway and Limerick. The appointments of ANPs to posts in Sligo are imminent and we await the appointment of nurses to Cork.

Electronic Patient Records The programme has also implemented an integrated electronic patient record (EPR) to help improve quality, safety and efficiency of patient care. The EPR is stored centrally and using a secure internet connection allows authorised healthcare providers regardless of geographical location to share important clinical information for individual patients. Fast access to clinical information means healthcare staff can provide better care to patients. The EPR also facilitates health service monitoring, evaluation and

Programme Scoops Limelight Award The National Clinical Programme for Epilepsy was awarded an international nursing award for its description of the new National Epilepsy Service of Ireland. The entry, Integrating Epilepsy Care in Ireland through Advanced Nurse Practice, outlines steps that can be taken to transform epilepsy care in Ireland through a model of advanced nursing practice. The Limelight award is part of the international care challenge series by Sanofi, which allows nurses from around the world to showcase nursing innovations. As part of winning this award, a video was created to

support sharing best practice. Go to www.hse.ie/epilepsyprogramme.

planning as large volumes of data are readily interrogated and analysed.

The epilepsy EPR was designed, developed and implemented by a multidisciplinary team of Irish experts in Beaumont Hospital. Epilepsy centres in Dublin (St James’s, Beaumont and Connolly hospitals), Limerick and Galway are using the EPR. It is also supporting epilepsy outreach clinics in the intellectual disability sector and in maternity care. Details of all new patients are entered onto the EPR. Approximately 3,000 people with epilepsy now have their medical record stored in the EPR, which is having a positive effect on how epilepsy care is delivered.

Máire White, Lead Clinical Nurse from the Epilepsy Programme explains: “When the patient rings the epilepsy nurse or emails the service, the nurses have access to that person's epilepsy record at the point of contact. They can deal with any phone calls they get immediately, as they have the patient's history, their medication, their type of epilepsy – and they can make changes in their medication there and then on the telephone; post out the prescription so that patients get a seamless service.”

Complex epilepsy About 15 per cent of patients with epilepsy will require evaluation for possible brain surgery, either due to expanding brain lesions or scars that are causing drugresistant seizures. The programme has been re-developing the pre-surgical evaluation unit at Beaumont Hospital, staffing it adequately with round-the-clock nursing expertise and expanding the unit beyond the two beds that had been first opened in the early 1980s. A key innovation was the development of a similar fourbedded unit in CUH, with two monitored beds that will be connected by a virtual private network, using the same technology and standard operating procedures to have a truly national service for complex epilepsy.

The Beaumont unit is now a state-ofthe-art digital hub for multi-angle video EEG monitoring and is located in a prime, highly visible area within the Neurology Department of Beaumont Hospital. It is hoped that the unit in CUH will open towards the end of 2013.

Paediatric care The nurse-led programme that has been running for years in the two main paediatric

“It is great to be part of an organisation and programme that’s providing a really good quality of care, but very quickly showing that we can save money because we are not admitting patients to hospitals; we are reducing their attendances to the emergency department and the quality of care is superb.” hospitals laid the foundations for the structure of the National Epilepsy Care Programme. The approval of an additional three ANP positions to the current complement of clinical nurse specialists brings the total number of nursing posts to deal with chronic epilepsy care to nine for patients under the age of 16 years. The advent of the new children’s hospital will see the development of the largest single epilepsy department, on the site of St James’s Hospital. A satellite service with ANP input will be provided in CUH. “It is great to be part of an organisation and programme that’s providing a really good quality of care, but very quickly showing that we can save money because we are not admitting patients to hospitals; we are reducing their attendances to the emergency department and the quality of care is superb – and it’s something that we are evaluating on an ongoing basis,” concludes Máire White.

The programme wishes to thank everyone who continues to give of their time to the programme and to the continued work of improving the patient experience for patients with epilepsy. For further information go to www.hse.ie/ epilepsyprogramme.

22 Health Matters

Capital Developments

Phoenix Care Centre wins

Best Health Building Award

The innovative Phoenix Care Centre, which is located in Grangegorman, Dublin, has won Best Health Building at the Irish Architecture Awards.

O

ne of the country’s newest HSE mental health facilities, the Phoenix Care Centre in Grangegorman, Dublin, won the category of Best Health Building at the recent Irish Architecture Awards 2013 organised by the Royal Institute of the Architects of Ireland (RIAI).

The Minister for Education and Skills, Ruairí Quinn TD, presented David Clarke of Moloney O’Beirne Architects with the award at a ceremony in Dublin City Council.

Built at a cost of a21 million, the contemporary 54-bed Phoenix Care Centre is the state-of-the-art replacement acute mental health facility for St Brendan’s Hospital – Ireland’s oldest public psychiatric hospital, which operated on the 75-acre Grangegorman site for 199 years.

The former patients of St Brendan’s Hospital moved into their new accommodation in the Phoenix Care Centre in May 2013. The centre includes a psychiatric intensive care service, which provides a tertiary-level acute service for units in Dublin, Wicklow and the north east. This service is accommodated in two light-filled ground-floor 12-bed psychiatric wards, designed around a landscaped courtyard.

A Vision for Change The centre, built in line with the national mental health policy A Vision for Change, also accommodates two rehabilitation wards. These areas were designed to promote independent living and training, and include two assisted daily living kitchens, an art and pottery room and a therapy room. The rehabilitation unit’s shared dining and sitting rooms open onto rooftop terraces.

Speaking about the patient-centred design of the Phoenix Care Centre, Derek Dockrell, Project Manager, HSE Estates said: “The building has been designed with a focus on the patient and the patients' outcomes. The building uses daylight well and is bright and airy due to the good space standards; the building, landscaping and interior design all combine to provide a fresh and generous feel for those living and working in the building. The Phoenix Care Centre provides a positive environment for patient care and treatment, and Moloney O'Beirne should be congratulated for this.”

Carmel Kitching, Mental Health Manager Dublin North City added: “The patients have settled very well into their new accommodation and are enjoying their

+ The exterior of the new Phoenix Care Centre in Grangegorman, Dublin.

“The building has been designed with a focus on the patient and the patients' outcomes.” new surroundings.”

The Phoenix Care Centre is the first new building to be constructed as part of the redevelopment of the original St Brendan’s Hospital site. The campus aims to provide a new urban quarter and a campus for healthcare and education. Grangegorman is an initiative aimed at rejuvenating the north inner city through healthcare, educational and transport initiatives. The HSE is currently working with the Grangegorman Development Agency (GDA) to finalise plans to build a new primary care centre on the Grangegorman site which will provide state-of-the-art primary care facilities to the local population.

The project was delivered by the GDA, the statutory body responsible for the development of all facilities on the Grangegorman site. The GDA also acted as the contracting body.

+ The courtyard at the Phoenix Care Centre.

The Wolfe Group is an agency that specialises in organisational reform, quality and audit, and regulation support in Health and Social Care Services.

Established in 1999 by Joe Wolfe, an ex-Director of Services, The Wolfe Group works across all areas of the Health and Social Care spectrum including the acute and primary care, disability, mental health, childcare, elderly and maternity sectors. The company has three divisions, notably: an organisational development and healthcare reform division; a quality and audit and regulation support division; and a training division. With a considerable team of full, part time and sessional staff, they have extensive expertise in the delivery and management of health and social care services.

Through their extensive and continued work with many agencies nationally, The Wolfe Group have a unique understanding and awareness of the Irish Health and Social Care system. The Group has a wide range of customers across the health and social care spectrum in addition to working with a considerable number of voluntary and statutory service providers.

They have also carried out work for the Health Service Executive, the Department of Health and Children, the Mental Health Commission, the National Disability Authority and the Health Research Board.

Joe Wolfe

Organisational Development and Reform • Strategic development and planning • High level system development, review and implementation • Governance training and support • Risk Register development • Quality system development, review and implementation • Policy, procedure and guideline development • New service development and organisational reform

Quality and Audit, and Regulation • Pre-HIQA and MHC inspections against standards and regulations • Support on preparing for and responding to regulation • Development and improvement of quality systems • Independent audits • Fit-person training and mentoring • Training for managers and staff in preparing for regulation and inspection

Training We specialise in developing and delivering bespoke, skills based training. Some of our programmes include: • • • •

Adult protection and child protection training Practical audit training Medication management Supervision training

• Risk assessment and management • Documentation and care planning • Management training programmes (skills based)

For more information about The Wolfe Group, get in touch on tel: 056 7793793, or visit www.thewolfegroup.ie

24 Health Matters

Dementia

Introducing the National Dementia Education Programme The Dementia Education Programme ensures that dementia services are underpinned by a person-centred model, reports Mary Manning, Interim Director, Nursing and Midwifery Planning and Development.

T

he National Dementia Education Programme in Ireland, a resource for nurses and other healthcare staff who care for people with dementia, is available through the Office of the Nursing and Midwifery Services Director and designated HSE areas.

Dementia is an illness that affects the brain. When someone has dementia, brain cells are damaged and die faster than they do normally. Losing brain cells means that the person begins to lose the ability to do things. Often it affects memory first and the person may become confused about where they are, what day it is and who people are.

In Ireland there are currently over 41,000 people living with dementia, and this number is projected to increase to over 100,000 by 2036. People with dementia will come into contact with a wide range of staff working across all care areas. It is estimated that at least 40 per cent of people with dementia are currently in residential care and 18 per cent of acute medical beds are occupied by people with dementia.

Education and training in the detection, assessment and diagnosis of dementia are crucial to enhance services and quality of care for both the person with dementia and their families and carers. Therefore, there is a tremendous need for a national dementia

+ Mary Manning, Interim Director, Nursing and Midwifery Planning and Development.

education programme in Ireland, spanning all care groups and areas of work.

Background In 2008 funding was granted from the National Council for the Professional Development of Nursing and Midwifery to develop and implement a person-centred

educational programme for staff who care for older people with dementia in acute, residential, mental health and community care settings. Since the establishment of the National Steering Group for the National Dementia Project in 2008, a diverse group of people have worked together to bring their vision to fruition: to develop and

Caring for a person with dementia in their own home The home environment is a unique caring environment which brings huge benefits but also many challenges. It is important for home help workers and people with dementia to find positive ways to cope with the necessary adjustments in their homes and their lives as their dementia progresses. With this in mind, an information booklet and CD entitled Caring for the Person with Dementia in their Home has been developed, in conjunction with the Alzheimer’s Society of Ireland, as an aid for home help workers.

The booklet contains information about dementia and practical advice on caring for a person with dementia in their own home. The information booklet and CD have been distributed to all home help co-ordinators and directors of public health nursing to distribute to the home-help workers in their areas.

There are approximately 11,000 part-time home help workers in the HSE and approximately a further 3,500 home help workers employed by voluntary agencies that receive funding from the HSE. The Alzheimer’s Society of Ireland has also distributed the booklet widely throughout its services. It is currently used as part of on going in-service education for home health workers.

Health Matters 25

Dementia launch a multi-modular person-centred dementia education programme. At each stage of its development, the programme has taken into account both international best practice guidelines and the education needs of nurses and care staff in Ireland.

Dementia Education Programmes The programmes include a staff e-learning programme on early identification of memory problems in the older person, a Dementia Champions Programme, an information booklet and DVD for home help workers, and information posters on the differences between depression, dementia and delirium. A new programme called Responsive Behaviours: Understanding and Supporting the Person with Dementia has recently been launched.

The educational programmes not only deliver up-to-date information on dementia and dementia care, but are designed to foster an environment where participants can examine and challenge their own unconscious behaviours and beliefs in the area of caring for a person with dementia.

Roll Out To date, the Enhancing and Enabling Well-Being for the Person with Dementia programme has been delivered to over 1,500 staff working across all care groups in the four HSE administrative areas.

This programme incorporates traditional classroom learning, experiential learning and work-based activities. Some 80 staff have completed the dementia champion module, Enhancing Person-Centred Care Dementia Care (Level 8), and a further cohort of dementia champions have enrolled to do the programme in October 2013 at Dublin

An e-learning programme, Early Identification of Memory problems in the Older Person, was developed and is available on www.hseland.ie. The programme aims to equip health care professionals with the skills to identify memory problems, to differentiate between different types of dementia and delirium and to look at memory problems within a broader social and personal context, thus mobilising therapeutic help earlier and maximising outcome potential.

City University. The information booklet and CD have also been sent to all home help co-ordinators and directors of public health nursing for distribution locally.

Evaluation A programme review board chaired by Patrick Glackin, A/Area Director, ONMSD HSE West and Chairperson of the National Dementia Steering Group, has been established and meets annually to review the programme and to recommend changes to the programme based on the feedback from the co-ordinators. A full evaluation of the generic programme was completed in 2012. The evaluation was carried out by an independent researcher and used both quantitative and qualitative methodologies. Overall the programme evaluated very positively.

Future Plans Work will continue on developing and enhancing our educational programmes as part of a three year large-scale project, funded by Atlantic Philanthropies and the HSE, entitled Elevator: Developing Dementia Skills Capacity in Communities and Workplaces. The aim of this project, led

by Dr Kate Irving of DCU, is to create a more educated workforce spread across a wide range of health, social care and community settings, including primary care as a priority.

Acknowledgements The valued contributions from our collaborators, especially Dr Kate Irving, DCU; Professor William Molloy, UCC; Mr Pat Kenny, HSELand; the Alzheimer’s Society and Dementia Services Information and Development Centre (DSIDC); HSE Communications and the Dementia Education Group brought a richness of experience and knowledge which greatly enhanced the programme. Our thanks also to all the healthcare staff who facilitated the development of the education programme through their participation and contribution during the needs analysis, piloting and evaluation phases of the project.

You can access all the dementia education resources on www.hse.ie/dementiaeducation.

For further information contact Mary Manning, Interim Director, Nursing and Midwifery Planning and Development. Email: marym.manning@hse.ie.

“In Ireland there are currently over 41,000 people living with dementia, and this number is projected to increase to over 100,000 by 2036. People with dementia will come into contact with a wide range of staff working across all care areas.”

New One Day Programme on Responsive Behaviours A new programme called Responsive Behaviours: Understanding and Supporting the Person with Dementia has recently been launched.

Responsive behaviours are a means of communication reflecting a response to something negative, frustrating or confusing in the person’s environment.

The programme builds on enhancing and enabling wellbeing for the person with dementia. Participants move from knowledge and comprehension to application using problem-based learning. They are empowered to adopt person-centred care that brings together ideas and ways of working with the lived experience of people with dementia that emphasises communication and relationships.

The three videos used as part of the programme are available on the HSE website at www.hse.ie/ dementiaeducation.

We take cancer personally

Patients are at the heart of everything we do at Roche.

They motivate and inspire us to produce innovative medicines and therapeutic solutions that will continue to transform the lives of people with cancer around the globe.

We’ve come a long way, but there’s still a long way to go. Fortunately, no one takes cancer more personally than we do.

P10/11/12

Health Matters 27

Cancer Screening

Vigilance urged as 3 in 10 still not having free smear test Female health professionals should avail of their free smear test to protect against cervical cancer – but new statistics show that many are going without.

A

ccording to CervicalCheck – the National Cervical Screening Programme, 30 per cent of women aged 25-60 have still not availed of their free smear test. Having regular smear tests is the best protection against cervical cancer for women aged 25-60. By avoiding their smear tests, women are putting themselves at greater risk of cervical cancer.

At present, 78.5 per cent of the people working in the health service are women.

Health service staff lead incredibly busy lives and while looking after the needs of those in your care it is all too easy to neglect your own health and wellbeing. A smear test only takes a few minutes, and for women aged 25 to 60 it is the best way to prevent a cervical cancer developing.

Cervical cancer Cervical cancer is a cancer of the cells of the cervix (neck of the womb). Early detection by smear test, and treatment of changes in the cells of the cervix, can prevent a cervical cancer developing. The best way to detect changes in the cells of the cervix is by having regular smear tests.

Dr Gráinne Flannelly, Clinical Director of CervicalCheck, is urging all women aged 25 to 60 to go for their free smear tests.

She said: “The fact that so many women are avoiding this simple, free test is a cause for concern. I truly hope that women who have not yet had a smear test will take five minutes out of their busy day to be proactive about their health. A smear test is nothing to be embarrassed about. It only takes a few minutes and doctors and practice nurses do hundreds a week.”

Over-50s ignoring need CervicalCheck is also aware that women aged over 50 are less likely to have their smear tests. Even if a woman is aged over 50, has reached the menopause or has finished having her family, she still needs to have regular smear tests. It’s just as

important for a woman of 56 to have a smear test as it is for a woman aged 25.

CervicalCheck – the National Cervical Screening Programme provides free smear tests for women aged 25 to 60. There is a choice of over 4,000 male and female smeartakers (GPs, doctors and practice nurses) nationwide – and it’s free.

How to arrange a free smear test Women don’t need an invitation letter or to register with CervicalCheck. To arrange a smear test they can simply contact a

registered smeartaker of their choice to make an appointment. GPs, practice nurses, women’s health, family planning and well woman clinics all over Ireland are registered to provide free smear tests. Details of all registered smeartakers are available at www. cervicalcheck.ie or by calling CervicalCheck on Freephone 1800 45 45 55.

Once a woman has had her first CervicalCheck smear test, the programme will let her know when her next smear test is due. A woman can also find the date of her next test by checking online at www.cervicalcheck.ie.

28 Health Matters

Oncology

Facing Forward: Beaumont Oncology Service Beaumont Hospital staff describe how patients' recovery from cancer is supported at the hospital. necdotally, patients have reported to us that their cancer journey is firstly a physical battle and secondly a psychological battle. They have reported this in terms of dealing with the psychological impact of cancer once they have finished their chemotherapy treatment. The oncology social workers and nurse specialists became aware of many patients who had completed their treatment (including those who journeyed well in the course of their treatment) and were now experiencing difficulty in adjusting back to their new ‘normality’. They said that they felt bereft and very alone as they tried to adjust to a life ahead. Many stated that their “safety net was gone” when their visits to oncology day unit ended. We recognised a gap in our service whereby patients required further support to face forward after they completed their cancer treatment.

We came together as a working group to plan what support we could offer these patients, with maximum use of available resources. At this point we invited the oncology multidisciplinary team (physiotherapist, occupational therapist, dietician, oncology CNM) and nurses from the Daffodil Centre to be involved. We decided to run a pilot support group which would take the structure of a single support day to be held off-site. This support day could not have taken place without the help of the staff from Beaumont Hospital’s Daffodil Centre, who facilitated the day by managing all the administration and organisation, and our friends at the Ross Nugent Foundation who provided the bulk of the funding for the day. The Irish Cancer Society kindly donated to our day too.

People with a primary cancer who had completed all of their cancer treatments were invited to attend with their partner or main support who was significant in their cancer journey.

Talks and Workshops The day opened with a talk on the

www.thinkstockphotos.com/iFuse

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emotional effects of cancer by a psychologist. We chose a psychologist who worked outside our service to enable each patient to have a neutral experience. This was followed by a series of workshops: diet and cancer; move more: exercise and cancer; fatigue; complimentary therapies; and the emotional effects of cancer. The final part of the day focused on life after chemotherapy/radiotherapy, focusing on both short and long-term effects.

An evaluation highlighted that patients found the day beneficial and informative.

Participants found that acknowledgement of the difficulties, especially psychological ones they faced, to be very helpful.

Furthermore, sharing this with other participants on the day was very reassuring that that they were not alone. It was suggested by participants that more

time was needed to be allocated to the workshops in order for maximum benefit to be achieved. The inclusion of partners or the 'forgotten anchor' was well received as it gave them an opportunity to acknowledge and validate their own stress levels. It was suggested that it would be beneficial to run the workshops while patients were undergoing cancer treatments. This is something that we are currently exploring.

We ran our second support day in May. We are aiming to run the support day twice yearly, with a continued focus on empowering our patients to adapt to life after cancer.

This article was prepared by Emma Gannon, Ciara Mulkerns, Ciara Savage, Grainne Walsh, Mairead Traynor, Paul Troy, Teresa Doyle, Eleanor Sweney, Aisling Lyons, Alison Wills and Clodagh McHugh.

Health Matters 29

Cancer

NATIONAL LUNG CANCER QUALITY AND AUDIT FORUM An inaugural National Lung Cancer Quality and Audit Forum was held in May. Its purpose was to establish an annual multidisciplinary meeting focusing on quality and the audit of lung cancer services around the country.

T

he forum was designed to build on local clinical governance arrangements in order to operate as a cohesive national clinical network for the purpose of clinical audit, sharing of good practice and problem solving. It was also created to identify best practice models and ensure standardisation of lung cancer services nationally.

The format of the day included presentations and workshops, and the event concluded with a lively debate on whether lung cancer screening should be performed in Ireland. The invited participants were members of national lung cancer multidisciplinary services including specialities from respiratory, thoracic surgery, radiology, pathology, medical oncology, radiation oncology, nursing and data management.

Dr Ross Morgan, respiratory physician, chaired the meeting. He welcomed participants, highlighting that the forum was an opportunity for lung cancer multidisciplinary team members to meet and share their expertise. He stated that this was the first step in standardising practices nationally, benefitting the patient population in their services.

Dr Susan O’Reilly, Director of the National Cancer Control Programme, spoke of the centralisation of cancer services to designated cancer centres over the past number of years. Dr O’Reilly referred to the increasing incidence in lung cancer cases nationally and emphasised the value of prevention, early diagnosis and prompt access to expert care in highly organised multidisciplinary cancer systems, which lead to better patient outcomes.

Dr Deirdre Murray, NCCP Health Intelligence spoke of the introduction of rapid access clinics, which has meant that patients with suspected cancers can be seen and assessed by specialist cancer teams in a timely manner. She referred to

+ Dr John Bruzzi, Consultant Radiologist GUH; Rosie Murphy, Lung Cancer Coordinator, Limerick; Dr Susan O'Reilly, National Director, NCCP; Mr Vincent Young, Consultant Cardiothoracic Surgeon, St Vincent’s University Hospital; Dr Deirdre Murray, Cancer Intelligence, NCCP; Dr Seamus Linnane, Locum Consultant Respiratory Physician, Beaumont; and Dr Ross Morgan, Consultant Respiratory Physician, Beaumont.

the high rates of referrals to rapid access clinics during 2012.

A total of 43,805 new referrals presented at breast, lung and prostate clinics. Some 2,751 of these new attendances presented to the rapid access lung clinics. Some 89 per cent of these new patient referrals were offered an appointment within ten working days at rapid access lung clinics and 909 new primary lung cancers were diagnosed.

Workshops Following the presentations, participants had a choice of attending one of four workshops. These included lung cancer diagnostics, lung cancer surgery, tissue sampling/medical oncology, and nursing/ data management.

The aim of each workshop was problem solving and the sharing of best practice models. Each group identified and agreed key areas requiring standardisation and national protocols for service improvement.

Key issues addressed and recommendations from each workshop were presented back

to the larger group following the workshops.

A debate on whether lung cancer screening should be performed in Ireland was held, with Dr Dermot O Callaghan the speaker for the motion and Dr Patricia Fitzpatrick the speaker against.

It was a lively debate moderated by Dr Susan O Reilly, highlighting international evidence on the benefits and harm of lung cancer screening, the requirements, and the economic implications. The speaker against the motion won on the day though there were a number of participants who remained undecided as to whether lung cancer screening should be available in Ireland.

Dr Mary Hynes, Acting Deputy Director of the NCCP, concluded proceedings, reiterating the value of holding such a meeting and stressing that it was an opportunity for national multidisciplinary lung cancer teams to come together and focus on the quality and audit aspects of their services. She thanked all participants for their contribution to the meeting and is looking forward to it being an annual event.

30 Health Matters

Cancer

National Programme for Neuroendocrine Tumours Professor Dermot O’Toole, a Consultant Gastroenterologist at St James’s Hospital and Trinity College Dublin, is to lead a project to develop a national programme for neuroendocrine tumours, building a network involving the designated cancer centres in Dublin, Cork and Galway.

“While neuroendocrine tumours represent a rather rare disease, many patients live a long time so the overall prevalence is quite high. We estimate that there are at least 2,000 cases in Ireland (the total number of people living with and managing their condition on an ongoing basis) at any one time and this clearly underscores the need for a dedicated network in Ireland, which is the approach we are now taking.”

Professor O'Toole Appointed The National Cancer Control Programme recently announced the appointment of Professor O’Toole as the national clinical lead of the Irish Neuroendocrine Tumour (I-NET) group. He has a specialist interest in digestive tumours, especially NETs. Professor O’Toole has worked closely with the NCCP to further develop a multidisciplinary group devoted to NETs in St Vincent’s University Hospital.

A graduate of TCD, he has worked as a professor in the University of Paris attached to Beaujon University Hospital – the leading French unit devoted to pancreatic tumours and an internationally-recognised group in the neuroendocrine tumour field (lead by

Professor Philippe Ruszniewski). Following almost nine years in France, he returned to Dublin to take up his position in St James’s and TCD. Announcing the appointment of Professor O’Toole, the Director of the National Cancer Control Programme Dr Susan O’Reilly said she was delighted that a clinician with his expertise and experience had agreed to assume the role of national clinical lead of the I-NET group.

“This development is ultimately about our patients. This is an uncommon cancer and requires a particular focus and approach. We want to ensure that patients are diagnosed as swiftly as possible and have access to multi-disciplinary teams to provide a comprehensive diagnosis and to allow for the most appropriate treatment plan to be put in place,” she said.

“We are taking a network approach, which means that patients across the country will have access to the same standardised service and will be seen and treated directly by the clinicians with the most experience and depth of knowledge in this particular specialised area.”

www.thinkstockphotos.com/istock

N

euroendocrine tumours (NETs) are cancers formed by cells emanating from endocrine components of many organs and tissues and may release hormones or peptides in response to signals from the nervous system. They occur at various sites in the body but are most commonly diagnosed in the digestive system, particularly the stomach, pancreas and small bowel. Many NETs are benign – they do not invade the surrounding tissue or spread to other parts of the body. However, around 200 invasive NETs are diagnosed annually in Ireland, with the most recent statistics showing that 206 cases were diagnosed in 2010.

As neuroendocrine tumours are an uncommon form of cancer, some patients in recent years had been referred abroad for treatment. The appointment of Professor O’Toole, along with the establishment of the network, will offer a fully comprehensive and clinically advanced treatment and management regime for patients. Although a minority of patients may still require specialised therapy abroad, the majority will access treatment and care in Ireland.

This new approach will provide for a dedicated service for all patients, regardless of location. It also means that Ireland now offers a service on a par with similar services internationally.

Explaining the challenge facing those working with patients with NETs, Professor O’Toole explained that NETs “is a complex group of tumours where diagnostic methods and therapies vary widely and require a dedicated multidisciplinary approach.

International evidence suggests that optimal survival and reduced mortality are achieved by focusing and concentrating a programme to a limited number of institutions with a high volume of patients, thus providing the necessary diagnostic and therapeutic skills".

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32 Health Matters

COMMERCIAL PROFILE

AN INNOVATIVE SOLUTION TO MANAGING SHARPS WASTE Cost savings, sustainability and reduced risk.

W

e are in times where hospitals and healthcare organisations across Europe are tasked with meeting various targets such as saving costs, protecting staff from injuries and improving sustainability. Innovative products and services can help fulfill one, if not all these targets by offering contemporary solutions.

Let’s take waste for instance. Processing waste compliantly is a necessary requirement for hospitals. Often, this service can be taken for granted and isn’t truly explored in depth to see if there are efficiencies to be gained.

However, there are innovative waste service organisations out there in the marketplace such as SRCL. With operations based in Dublin and Antrim, one of the services that SRCL provides

hospitals with is their innovative solution to dealing with sharps waste in a safer, more cost-effective and sustainable manner.

managing sharps waste SRCL’s Sharps Management Service incorporates UN-approved Bio Systems reusable containers that can be used up to 600 times after washing and disinfection as opposed to traditional, single-use containers that are sent for disposal after a single use. This tried and tested service also improves waste segregation and reduces the potential risk of needlestick injuries.

How does it work?

The innovative process starts with filled sharps containers being collected by SRCL and then taken to their treatment

Benefits The use of Bio Systems reusable containers has numerous benefits such as; reduced costs, reduced environmental impact, reduced risk of needlestick injuries and improved compliance via waste segregation at ward level.

Results show that: • A typical 200-bed hospital will save approximately 5978 kgs of carbon per annum when comparing the use of SRCL’s Sharps Management Service to single-use containers. This is the equivalent to running a car for a year!

• Bio Systems reusable containers offer significant cost savings over the total costs involved against using single-use sharps containers.

• Bio Systems reusable containers are safe, puncture-resistant and provide improved compliance as all containers are delivered to the hospital fullyassembled and fitted with absorbent material. More specifically, the 30 litre

facility where they are tracked, scanned, weighed and placed on the highly sophisticated, robotic processing line.

Containers are opened, emptied and disinfected using an automated state-ofthe-art robotic system.

Finally, the disinfected containers are meticulously inspected, reassembled and fitted with absorbent material, before they are returned back to the healthcare facility in a ready-to-use condition, for the cycle to continue.

The use of reusable Bio Systems containers also saves time for clinical and hospital staff as administrative tasks of stock and inventory control, particularly associated with single-use sharps containers, are not required to be undertaken.

foot-pedal operated container gives the benefit of hands-free operation, and the 7.5 litre container restricts hand access when disposing of used sharps due to the design of the aperture.

• The 30 litre Bio Systems reusable container combines the benefit of a conventional rigid bulk container with that of a sharps container. Both sharps and liquid wastes can be placed in the same bin, thereby reducing space and lessening the risk of incorrect segregation.

• No Signing or Dating: The time consuming task of assembling and signing/dating each single use container both on opening and sealing of the filled container is eliminated

by SRCL’s Sharps Management Programme. The fact that the Bio Systems containers are delivered and assembled, fitted with absorbent material, releases healthcare professionals to fulfill core functions of patient care.

SRCL’s innovative solution to managing sharps waste is not just cost-efficient for hospitals, but also compliant, and environmentally sustainable with proven results. Call: 1800 937 628, email: srclireland@srcl.com or visit: www.srcl.ie to find out more.

Health Matters 33

Clinical Programmes

New Surgery Policies Launched The new National Model of Care for Acute Surgery and National Policy and Procedure for Safe Surgery aim to ensure high-quality surgical care for patients.

T

The National Clinical Programme for Surgery, a joint initiative between the HSE Clinical Strategy and Programmes Directorate and Royal College of Surgeons in Ireland recently launched the National Model of Care for Acute Surgery and the National Policy and Procedure for Safe Surgery The Model of Care for Acute Surgery was developed given that up to 60 per cent of the work undertaken in many surgical departments is on patients requiring acute surgical care. These patients are frequently the sickest, are elderly and have co-morbidities with often result in poorer outcomes.

It is against this backdrop that the Model of Care for Acute Surgery sets out the principles and strategies necessary to ensure the provision of high-quality acute care for surgical patients in Ireland.

Adherence to these principles, strategies and underlying critical considerations will ensure that patients experience:

with appropriate aftercare and planned discharge with monitored outcomes.

•E xcellent communication and respect for their autonomy and privacy.

•A n optimum outcome with good aftercare, support and follow-up.

Speaking at the launch, Mr Tony O’Brien, Director General of the Health Service Executive (HSE), said that: “The adoption of global best practice principles in surgical care, patient safety, change management and business process re-engineering will be the keys to success as we work together to deliver the much needed change and reform that our health service requires’.

He continued by saying that he ‘hopes the principles contained in the document will

guide all hospitals and groups of hospitals in their efforts to provide the best care possible for their patients”. The Model of Care for Acute Surgery is available for download at www.hse.ie/surgery The National Policy and Procedure for Safe Surgery is based on World Health Organisation Guidelines for Safe Surgery and builds on previous work undertaken in Ireland in relation to safe surgery.

Promoting and supporting safe surgery is an integral part of the National Models of Care for Surgery (National Model of Care for Elective Surgery and National Model of Care for Acute Surgery) and the Productive Operating Theatre programme. For more information go to www.hse.ie/safesurgery

• Safe, quality care in a suitable environment.

• Appropriate and timely attention from senior doctors working within a dedicated multidisciplinary team.

• Prompt diagnosis, appropriate treatment and, where necessary, timely surgery

The Productive Operating Theatre (TPOT) Programme Poster Competition: Winners The TPOT programme commenced in Ireland in 2010 with five pilot sites. These pilot theatres delivered annual productivity savings of e3 million and inventory savings of e300,000.

The winner of a recent TPOT poster competition was Sligo General Hospital.

The TPOT lead is Alison Smith. The team analysed delays around the first patient into theatre and introduced a theatre admission area, which improved efficiency. The runner up was Portiuncula Hospital, Ballinasloe.

+ At the launch of the National Model of Acute Surgery were members of the National Clinical Programme in Surgery team, from left: Niamh Keane, Dr Ken Mealy, Emeka Okereke, Gerry Kelliher, Mary Flynn, Dr Seán Johnston, Martha Ni Chuanaigh, Prof Frank Keane and Therese Dalchan.

+ At the launch of the National Policy and Procedure for Safe Surgery were (l-r): Dr Ellen O’Sullivan, Dr Ken Mealy, Dr Áine Carroll, Professor Patrick Broe, Grace Reidy, Gillian Whyte, Maria Lordan Dunphy, Eddie Byrne, Professor Frank Keane.

34 Health Matters

Cardiac Arrest

Irish people slow to respond to heart attack symptoms Recent findings of HRB-funded research shows that Irish people are slow to contact ambulance services with heart attack symptoms.

P

atient behaviour is one of the biggest causes of delay in getting to hospital when suffering a heart attack but this can be changed using a short educational intervention, according to the findings of HRB-funded research from the School of Nursing and Midwifery at Trinity College Dublin.The main results from the study team – Dr Gabrielle McKee, Dr Sharon O’Donnell, Ms Mary Mooney, Ms Frances O’Brien and Professor Debra Moser – are beginning to emerge in international publications.

The first major findings, involving 1,894 Irish patients, were recently published online in the International Journal of Cardiology. These indicate that when experiencing heart attack symptoms, people who delayed longest tended to consult GPs or take more medications and were reluctant to use an ambulance.

This resulted in pre-hospital delay times of around four hours. “These delay times are on the high side and have a major bearing on the type of treatment available to the patient and consequently patient outcomes,” says Dr McKee. In addition to the above factors, patients often don’t relate symptoms to a cardiac cause and certain attributes of their symptoms may contribute to this difficulty. To further understand this, the research team characterised the patients into slow and fast onset heart attack. A slow-onset heart attack is characterised by the gradual onset of mild symptoms. A fast-onset heart attack includes the sudden onset of severe and continuous chest pain – the typical features we see in the movies; a 'Hollywood heart attack’. The examination of a subsample of 893 patients not only indicated that 65 per cent of the subsample had slow onset heart attack characteristics, but that in this group pre-hospital delay was significantly longer

than their fast-onset counterparts (3.5 versus two hours).

Educational Intervention Another major aspect of this work was to find out whether a short educational intervention given to patients who were at risk of heart attack would help reduce their pre-hospital delay time. This individualised intervention reinforced the fact that it’s not always about a sudden pain in the chest and left arm. Instead, some people can experience symptoms that are gradual and intermittent rather than sudden and continuous.

The intervention advocated that if in doubt, it is essential that people act fast and call 999. From there, the emergency services will use specific questions to clarify if an ambulance is needed. The intervention not only caused a significant increase in knowledge, attitude and belief scores over time but found that that those who received the intervention and had subsequent heart attack symptoms managed to reduce their time of getting to hospital from 4.6 hours down to an amazing 1.7 hours.

“Our findings add further support for the recent Irish Heart Foundation campaign advocating for prompt, appropriate response to heart attack symptoms,” says Dr McKee. “The success of these individualised sessions suggests that patients who have had a heart attack need specific education regarding prompt response to heart attack symptoms before they leave the hospital. The team is currently trying to develop an app that could deliver the educational intervention via a website or smartphone.”

Questions about the research can be directed to Dr Gabrielle McKee – gmckee@tcd.ie.

+ Dr Gabrielle McKee.

“Some people can experience symptoms that are gradual and intermittent rather than sudden and continuous.”

Health Matters 35

Primary Care

Lymphoedema Service for patients in the community Kay Morris, Physiotherapy Manager at Our Lady of Lourdes Hospital in Drogheda, County Louth, tells Health Matters about an initiative to integrate treatment for Lymphoedema in the community setting.

L

Our Lady of Lourdes The physiotherapy department in Our Lady of Lourdes Hospital (OLOL) has had a lymphoedema service for the past 11 years and has built up a large case load. To ease the pressure on the service and free up time to treat new patients, it was decided to train

+ Anne Keane, Elena Gallagher and Kay Morris, physiotherapists in Our Lady of Lourdes Hospital, Drogheda.

physiotherapists in the community to provide the maintenance part of the treatment.

A proposal was made to physiotherapy managers in primary care to allow community physiotherapists to receive the training necessary to enable them to provide this treatment. The physiotherapy managers in Cavan/Monaghan, Navan and Dundalk agreed, and to date 15 community physiotherapists have been trained.

Patients attending the service are given a record book which they take to their treatment sessions. If the patient’s condition worsens or changes, the patient is referred back to the physiotherapy department at the hospital and is seen as an urgent appointment. The team of therapists at the hospital is also available to provide support to the community physiotherapists over the phone if advice is required.

The programme, which has been running since June 2011, is working well. There is now more time to provide the intensive treatment to patients in the hospital and patients can receive their follow-up care closer to their homes in the community.

Similar programs are running with great success in England but this is one of the first programmes to integrate treatment

www.thinkstockphotos.com/istock

ymphoedema is a chronic condition in which the limbs and/or trunk and face swell due to an impaired lymphatic system.

There are two main types of lymphoedema: primary lymphoedema, which is genetic; and secondary lymphoedema, which occurs due to damage to the lymphatic system. The chief cause of secondary lymphoedema is damage to lymph nodes from cancer treatment. Lymphoedema cannot be cured but can be alleviated with treatment. If it is not treated it can become a severe and debilitating condition.

Studies have shown a range of problems associated with lymphoedema including pain, discomfort, difficulties with clothing, reduced function and mobility, social isolation and employment difficulties.

Lymphoedema can be significantly reduced with management but as it is a lifelong condition, patients will require ongoing care. The main treatment for lymphoedema has four components: exercise, skin care, compression and massage.

People with severe lymphoedema require intense treatment of massage and bandaging, which needs to be carried out daily for two to three weeks. This requires a high level of specialist training for the therapist. Once the lymphoedema has reduced, the patient needs to wear a compression garment and continue with exercise and skin care to maintain the improvement. These garments need to be replaced every six months and the patient needs to be re-measured each time.

This maintenance treatment requires less training by the therapist.

for lymphoedema in the community setting in Ireland.

The success of the initiative is attributed to the physiotherapy managers who took on this new service with no extra resources and to the trained physiotherapists who are providing such a valuable service to patients in their local community.

36 Health Matters

Capital developments

New Builds In HSE South Norma Deasy reports on the opening of a new community hospital, construction of an adult mental health unit and plans for a new specialist gastroenterology centre in Cork.

Kenmare Community Hospital Opened A new 40-bed replacement community hospital in Kenmare, built at a cost of a8 million, opened earlier this year. The new hospital, which is initially accommodating 19 residents, provides a much enhanced environment for residents, staff and visitors than its predecessor, which was built in 1936.

It is designed to provide residential care for people in the region as well as a wide range of community supports including convalescent, respite and hospice care.

It also includes a specific hospice-friendly suite for family and carers of relatives who require the service. The suite features a separate sitting room, kitchenette, sofa bed and bathroom facilities. Funding for the suite was raised locally.

The new hospital measures 4,400 square metres, built on two levels specific to the requirements of our older population, complete with fully landscaped gardens.

The building also includes a mental health day care centre as a replacement service for a smaller day centre which relocated from an existing facility in Kilgarvan, as well as a new ambulance base and primary care team services. Locating these HSE services on the one campus in new facilities will enhance health service delivery for patients.

New acute mental health unit in Cork Construction is well underway on a new 50-bed acute adult mental health inpatient unit on the Cork University Hospital (CUH) campus. The unit will replace the existing 46-bed unit, with a15m being invested in the new build.

Developed in line with the requirements of A Vision for Change, the new purpose-built inpatient unit will provide accommodation for patients with a mental illness requiring mental health assessment, treatment and rehabilitation. The unit will provide a better environment for patients and will have an increased number of single and therapy rooms. It will include two 18-bed

+ Artist’s impression of the new inpatient 50-bed acute adult mental health unit to be erected on Cork University Hospital campus.

+ Denis O'Shea, the last resident at Kenmare Community Hospital, locks the door to the old hospital with Margaret O'Sullivan, A/Director of Nursing.

wards (all single en-suite rooms), a six-bed assessment/high observation ward, and an older person eight-bed ward, also with single rooms. The facility is also configured to be capable of providing a service to mother and infants in partnership with other services on site.

Dr Eamonn Moloney, Executive Clinical Director, HSE Cork South Mental Health Services said: “This investment in our mental health services is most welcome.

The new unit will provide a much enhanced therapeutic environment for our patients and will enable us to cater specifically for client groups with particular requirements, including older people. The new unit is very much a positive step forward and something that is welcomed by all staff working in the service.�

+ Pictured following the turning of the sod ceremony for a new 50-bed acute adult mental health unit on Cork University Hospital campus: Gretta Crowley, Operations Manager, ISA Cork; Dr Eamonn Moloney, Executive Clinical Director, Mental Health; Minister of State Kathleen Lynch TD; Pat Healy, National Director, Social Care; Damien Godkin, Service User Representative; Tony McNamara, CEO, Cork University Hospital and Deirdre Scully, Area Manager, PCCC Cork.

It is envisaged that the entire construction project will be completed within 15 to 18 months and BAM Construction Ltd are the appointed contractors.

Regional Gastroenterology for Mercy University Hospital A new specialist centre for gastroenterology catering for patients in the region will be built at the Mercy University Hospital. The new centre will have six endoscopy suites and provide colorectal screening under the National Cancer Control Programme. The centre has just gone out to tender for the design stage and the hospital expects to have the design team appointed by year end. The centre, which will measure over 2,200 sqaure metres and will cost a11.2 million to complete, is expected to be constructed by 2016.

Health Matters 37

Financial control

Play Your Part In The HSE’s Annual Internal Control Review Process The effective operation of the system of internal control is a key enabler in the achievement of the HSE’s objective of ensuring the appropriate and efficient use of resources, writes Tom Byrne, HSE Chief Finance Officer.

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• Assessing the risks and potential exposures which are likely to occur if those activities, services or functions are not properly performed.

• Reviewing existing management action, mitigating measures and controls and suggesting and recommending areas for improvement.

• Completing the controls assurance statement and attaching a risk register.

• Compiling the controls assurance statement staff register for your service.

• Completing the internal control questionnaire (this applies only to a sample of managers).

E

ffective internal controls are a fundamental element of a strong corporate and clinical management approach and culture. The HSE is required to conduct a formal review of the system of internal controls on an annual basis.

The organisation has in recent years developed a comprehensive and robust review process to support the continued development of the internal control system in the HSE. The review process underpins good governance by requiring evidence of clearly defined accountability, responsibility and authority, which is reviewed by all managers as part of the performance monitoring process and has been an important enabler of systems improvement and reform within the health service.

Why do we need a good internal control process?

The following benefits accrue where a good internal control system is in place: • Quality improvement: good and clear internal control procedures minimise errors for patient safety, and save time and money.

• Learning: the existence of internal controls help employees learn the right way to do

their job and correct procedures needed to carry out their tasks.

•P rotection and authorisation: internal controls give comfort to staff that they are protected if they acted in good faith and within the specified guidelines.

•P erception of detection: the existence of internal controls acts as a deterrent to those considering fraud, increasing the risk of detection.

Steps involved in the review process A formal review of the effectiveness of internal controls has commenced in Q3, facilitated by the Finance Directorate, working in collaboration with the Quality and Patient Safety Directorate with regard to clinical governance matters.

For each manager this involves: • Reading the updated HSE Management Controls Handbook.

• Reviewing the key processes in place across services to provide an effective internal control environment.

• Identifying the activities, services and functions performed in support of service objectives.

Next steps The director general’s report on the review of the effectiveness of the system of internal controls in the HSE will be produced by the end of March 2014. This report will summarise the outcome from the 2013 review. It will outline areas where significant progress has been made, and give guidance on areas where weaknesses have been observed or processes which need modification.

I am very much aware of the many demands and pressures faced by staff on a daily basis across the service. I also recognise that this process is a new and emerging requirement for many health and social care professionals and requires clear information. Assistance will be provided by Rosemary Grey, who is the HSE lead on this project, as required.

This review process is an important part in the reshaping of the health service and it is very important that it is supported to the maximum extent possible by all staff members across the country.

For further information contact Rosemary Grey at (045) 880405 or email rosemary.grey@hse.ie.

Coming

to

soon

a screen near

you

Everything’s online these days including payslips Books? Yes. Movies? Definitely. Travel reviews? Sure. Music?

Absolutely.

The list of what’s available online these days is virtually endless. And this has freed people in countless different ways. Whether you want to pay a bill while you’re on a rollercoaster or book a flight from the top deck of a bus, it’s all possible.

That’s why Core HR’s new initiative for the HSE makes so much sense. When fully deployed, it will replace the traditional paper payslip with an online version. So wherever you are and whatever device you use – a computer, tablet or smartphone – you can check your payslip as easily as watching a YouTube video.

Want to know more? Check out the details (online, naturally) at www.corehr.com

Health Matters 39

Self care

Taking Care Of Yourself It is vital that staff learn to practise good self care to alleviate the unique forms of stress which can result from caring roles, writes Karen Brennan, who has been has been integrating meditation and stress relief programmes into her life and work for more than ten years.

T

www.thinkstockphotos.com/istock

aking good care of yourself is very important for those who spend their time caring for others. As well as being satisfying, healthcare work can be physically, emotionally and spiritually demanding, whether you are a nurse, doctor, carer, social worker or therapist. Being present with patients in physical or emotional distress can be challenging as staff try to stay in touch with what they are feeling.

Compassion Fatigue (CF) symptoms are normal displays of stress resulting from the care giving work we choose to do, according to Eric Gentry, who is a leader in the field in the United States. It is interesting that many people working in healthcare haven’t heard the term. CF can result from caring for patients in physical and/ or emotional pain or stress. Internationally, there has been an increase in research in and treatment for CF since the 1990s.

Symptoms vary from person to person but can include sleeplessness, apathy, irritability, anxiety, loss of focus, increases in pessimism, etc. The good news is that compassion fatigue is a set of symptoms, not a disorder and responds well to skill building and committed self care. It is up to the individual to watch out for signs of fatigue in themselves and to act if they feel they need assistance.

Many professionals don’t feel comfortable talking about this topic, so it is important to normalise conversations about CF rather than feeling embarrassed or viewing it as ‘just an occupational hazard’. Carers' stress

should be acknowledged at all levels as treatable, and a sign of a caring person working in a challenging area. Lombardo and Eyre (2011) provide evidence of the importance of staff increasing selfawareness, communication skills, and recognising the types of situations, events and people that tend to trigger us.

Talking Helps From my own experience, talking openly with staff about stress-inducing situations has been very productive. Acknowledging that we all feel stress sometimes increases communication and trust amongst team members. Additionally, regular brief group relaxation sessions have resulted in stronger team cohesion.

Developing a healthy self care plan can be really enjoyable and rewarding. To begin with, make a list of issues in various areas of your life that may be contributing to your stress. Are there adjustments you can make? Can you reprioritise or delegate to others to create more space for yourself?

Review your available resources, including people with whom you can talk: a friend, colleague or counsellor. Training in compassion fatigue is also very helpful for staff who need skills to work in healthier and more self-sustaining ways.

Many people use self-soothing techniques to mitigate against the build-up of stress or fatigue during their working day. Deep breathing techniques, prayer, meditation or basic acupressure techniques

+ Karen Brennan.

such as 'tapping' are healthy habits worth forming, and which can be incorporated into the working day.

Good boundary management is a key skill which can be developed if you have a tendency to take work home with you.

Respect your need for your own time.

Nourishing yourself by spending time on your own interests is validating and affirming whether it's baking, golfing, fishing, painting or whatever you enjoy.

Committing to healthier self care practices can make a big difference to your life and work. Your own self care plan can be a tool, buffer and comfort on challenging days. This is a real prescription for wellness.

Dublin-based Self Care for Carers provides training and resources in this area: it is a training organisation responding to the challenges of providing healthy caregiving strategies for staff in healthcare settings. It was founded by Karen Brennan, who began her career in mental health after gaining a BSc in social psychology and subsequent MSc. As well as compassion fatigue, her professional areas of expertise include dementia and pre-dementia care as well as acute anxiety disorders. See www.selfcareforcarers.ie.

40 Health Matters

Primary Care

Counselling in Primary Care Service launched A new counselling in primary care service offers clients in distress six to eight sessions of counselling, delivered by qualified counsellor therapists, and is designed to support them through a difficult period. The new service will be available nationwide and has the potential to see up to 13,000 medical card holders in a full year.

C

ounselling in primary care (CIPC) is aimed at those with mild to moderate psychological difficulties. It is a shortterm counselling service of up to eight sessions with a professionally qualified and accredited counsellor therapist. CIPC is suitable for people experiencing difficulties such as depression, anxiety, panic reactions, relationship problems, loss issues and stress, who would benefit from shortterm counselling intervention.

The new service was launched in July

by Kathleen Lynch, Minister of State with responsibility for Disability, Older People, Equality and Mental Health; and Alex White, Minister of State for Primary Care.

People can be referred to the counseling service through their GP or primary care team. Guidance and referral protocols are being provided to GPs and primary care teams around the country. These information materials include advice about identifying clients who may be suitable for the service. Clients who are motivated and considered ‘ready’ for counselling generally get the most benefit from this type of service, i.e. when they avail of the counselling at the right time for them.

This service was developed to improve access to counselling and psychotherapy, in a primary care setting, for medical card holders with mild to moderate psychological difficulties. Some e7.5 million has been provided over two years for the roll-out of this service nationwide. Ten Regional CIPC coordinators have been appointed to link with GPs, primary care teams and the counsellors who will provide the service to clients.

Minister Lynch, said: “As GPs are the first point of call for people with mental health problems, it has long been recognised that there is a need to develop closer links between mental health care and primary care. In its programme for government,

+ Pictured on the occasion of the launch of the counselling in primary care service were Alex White TD, Minister of State for Primary Care; Dr Seamus Cryan, President of the Irish College of General Practitioners; Kathleen Lynch TD, Minister of State with responsibility for Disability, Older People, Equality and Mental Health; and Martin Rogan, HSE Assistant National Director for Mental Health.

this Government committed to developing these links, and to meet this commitment provided additional funding from its special allocations for mental health in Budgets 2012 and 2013 to develop this counselling in primary care initiative which will allow GPs to move beyond medication and allow them to provide counselling to people with mild to moderate psychological difficulties who are medical card holders.”

Minister for Primary Care, Alex White TD, said that “the key objective of the primary care strategy is to develop services in the community which will give people direct access to integrated multi-disciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists and other health care disciplines, and the launch of the counselling in primary care initiative is a welcome addition to the services available to the local primary care teams, providing more comprehensive health and personal care services in the community.”

According to Martin Rogan, Assistant

National Director for Mental Health at the HSE, “the counselling in primary care service provides a new way for us to support people with anxiety or depression.

This initiative, funded by mental health, is a joint collaboration with our colleagues in primary care. Counselling is not easy for the individual. It has been found to be most effective when the client is ready to take on the difficult work of addressing life’s challenges and difficulties with a skilled therapist. As a new national service, CIPC will greatly improve access to counselling and talking therapies for adults with a medical card who may not have been able to access this type of support previously.”

CIPC is not a crisis-intervention service and is not suitable for psychological/ psychiatric problems which are of a more severe nature. In these cases, and in consultation with their GP or another health professional, alternative support services may be recommended. CIPC will complement the full range of mental health services available.

Health Matters 41

Croke Park Agreement

Health Sector Progress Under Croke Park Agreement T

he third and final Public Service Agreement (Croke Park Agreement) Health Sector Progress Report was published in July 2013. The report details progress made in the implementation of the public service agreement in the health sector in the period April 1st to December 31st 2012.

As evidenced by the report, significant progress continued to be made in implementing change in the health service through the PSA. In the period under review, the service delivered improved results for patients in spite of reductions in staffing and increased demand.

Some of the key achievements outlined include:

of a50.255 million for the period Jan-Dec 2012. Savings reported included:

Hospital Consultants An agreement reached with the hospital consultant representative bodies, under the PSA, will result in the delivery of a range of flexibilities and efficiencies including roster changes, a strengthened management role for clinical directors; co-operation with the measurement of public/private mix, improved income collection, work practice changes, reduction in entitlement to historic rest days and more cost effective provision of on-call and call-out services.

• Extended working day: all grades of radiographers, in all HSE and HSEfunded hospitals, are liable to be rostered between the hours of 08.00 and 20.00, Monday to Friday.

• Out-of- hours payments: a new outof-hours payment system has been introduced, replacing the previous fee per case arrangements.

• Time off in lieu arrangements (TOIL) arrangements for on-call have been standardised.

Improved Access Access to services improved in many areas during 2012 and significant inroads were made in reducing the time that patients must wait for services. The number of people on trolleys was reduced by 23.6 per cent or 16,659 persons over the same period in 2011; 70 per cent of hospitals fully achieved the target of having nobody waiting for more than nine months for treatment and the number waiting over nine months was reduced by 91 per cent.

Employment Numbers The number of whole time equivalent posts (WTEs) in the health services reduced by 1,304 in the reporting period.

Procurement HSE Procurement achieved total savings

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The final proguress report produced under the Croke Park Agreement has identified significant progress in improving results for patients and implementing change.

• Medical, surgical and pharma, a12.832m •E quipment, laboratory and diagnostics,a8.869m •H otel services and utilities, a8.705m • Professional services a9.412m •L ogistics and inventory managementa10.437m

Radiography Service Savings estimated at a1.5m per annum will be made as a result of an agreement made with all radiography staff grades under the PSA. This agreement came into effect on February 1st 2012. Its key elements are:

Redeployments An estimated 2,400 redeployments and reassignments took place across the full range of health services for the period of the report. It is clear from the report that service managers and staff are implementing and co-operating with redeployment in order to ensure that services continue to be delivered despite reductions in overall staffing numbers.

Roster changes It is also clear from the report that roster changes were implemented routinely across all services in order to maximise efficiencies.

Non-Consultant Hospital Doctors An agreement reached at the Labour Relations Commission in October 2012 on annual leave/public holiday entitlements for NCHDs will result in estimated savings of at least a3.5m per annum.

In welcoming the publication of the final PSA Progress Report for the whole of the public service, Minister for Public Expenditure and Reform Brendan Howlin stated that savings of a1.8 billion have been facilitated under this agreement with the co-operation of staff and unions. The health sector was the largest contributor to this savings total.

The public service agreement has now been subsumed into and superseded by the Haddington Road Agreement. The Department of Public Expenditure has indicated that there will be no requirement for separate action plans/reports under the Haddington Road Agreement. Progress under Haddington Road will be reported as part of the overall reporting process for health service reform.

The third and final PSA Health Sector Progress Report may be viewed at www.hse.ie/go/crokepark.

42 Health Matters

Letterkenny Flooding

Letterkenny Hospital recovery plan on track following major flooding Bill Maher, CEO of the West/North West Hospitals Group, outlines how 40 per cent of Letterkenny Hospital was wiped out by flooding last July. He says the recovery plan is on track and the aim is to return all services in the shortest possible time possible.

I

f every cloud has a silver lining, then the cloud that dumped 57mm of rain in 15 minutes above and through Letterkenny Hospital on Friday July 26th, wiping out 40 per cent of the hospital, augurs well for the hospital’s resurgence. It was without doubt the most serious natural disaster to befall any Irish hospital and our focus since has been to re-establish services as quickly as possible and, where we can, improve on the facilities that existed prior to the flood.

As I write this, the interim emergency department has been phased in and all emergency department services have been restored, albeit in a temporary location. This was an incredible achievement and is a credit to the determination and willingness to go the extra mile by a large group of people led

by Sean Murphy, the general manager who has worked tirelessly with his team to return many services to the hospital in the shortest time imaginable. Although it was a view aired by many through the media that it would be many months before emergency department services would return to the hospital, the first patients were seen at the interim emergency department within 21 days of the flood.

Indeed, it was the quick thinking of many staff that prevented an even greater disaster and saved many critical areas of the hospital from being flooded, including the maternity unit and key electrical switch rooms. And it was the same calm thinking and speedy reactions that ensured that all patients were moved to safety and all staff were relocated without anyone coming to harm, despite flood waters, loss of lighting in locations, loss of lifts and monsoon-like conditions outside. Our colleagues in the Ambulance Service played a key role in the immediate aftermath and during the recovery phase, ensuring that all patients were brought to the most appropriate hospital for treatment.

New Block For those of you who aren’t familiar with Letterkenny Hospital, let me paint a before-and-after picture. Five months ago, the hospital officially opened a new a24 million medical block, incorporating an emergency department and acute medical assessment unit on the ground floor and three floors of ward accommodation, with 26 single en suite rooms and two four-bedded bays on each level. The new emergency department (ED) was designed with a highly-automated robotic pharmacy dispensing system, a separate children’s area and an area for acute psychiatric admissions. The new medical block also had an acute medical assessment unit. The work involved in commissioning the new block was extensive and many staff came in out of hours voluntarily to make sure the building opened on schedule. The people of Donegal had been eagerly awaiting this new ED and extra ward space for a number of years and its opening earlier this year was greeted with excitement and pride in equal measures. It was a modern, purposebuilt ED designed to optimise the patients’ experience; now it lies empty, devastated by the flood. All the hard work undone in less than 30 minutes.

Flood Water On Friday afternoon, July 26th, an unprecedented amount of rainfall led to local flooding in Letterkenny and flood water hit the hospital building from three different directions, gushing through its doors and windows. Very quickly the flood water, which included raw sewage from an overflow drain, flowed through the ground floor of the new medical block where the emergency and radiology departments are located, along the link corridor to the front wing of the hospital (which is one floor

+ Bill Maher, CEO West NW Hospitals Group.

lower) and poured down the stairs and into the lift shafts, cutting off one wing of the hospital from the rest.

Crucial sections of the hospital were affected by the contaminated flood water, including the ED, AMAU, radiology, CCU, haematology/oncology ward, cardiac investigations, both hospital chapels, the outpatient department, medical records, the kitchens, the pharmacy, the pathology department and the mortuary.

In the immediate aftermath a massive clean up operation involving Donegal County Council, the fire service, the army, volunteers and all available staff resulted in the hospital being completely cleared of flood water. Then the critical decontamination process had to begin.

Hospital Group Earlier this year, on May 15th, the Minister announced the make-up of the new

Health Matters 43

Letterkenny Flooding

+ L-R: Anne Flood, DON LGH; Dr Kieran Roarty, Medical SMO; Dr Stuart Boyd, ED Consultant; Dr Leon Viljoen, ED SMO; Dr Sinead O’Gorman, ED Consultant; Joanne Gibson, nursing student (white uniform); Nollaig Mc Bride, Staff Nurse (at back); Anne Neely, CNM2; Marjory Doherty, CNM2 (front row); Sean Murphy, General Manager LGH; Bernie Boyce, Clerical Officer.

hospital groups for the country. It was envisaged that Letterkenny, Sligo and Mayo would join with GUH, Portiuncula and Roscommon to become the West/ North West Hospitals Group and an official handover had been scheduled for the beginning of August. However, given the catastrophic consequences of the flooding, it was decided to bring forward the date and the group came into existence officially on August 1st. This meant that all the available resources of the hospitals in the group were provided to assist Letterkenny.

In particular, due to proximity, Sligo Regional Hospital bore the brunt of the emergency services that otherwise would have gone to Letterkenny. This meant that Sligo saw between 25 and 50 additional patients per day for the first three weeks following the flood. Mayo General is providing catering to Letterkenny, GUH is providing theatre time and clinical expertise and Portiuncula and Roscommon Hospitals

in turn are providing additional support to Galway, Mayo and Sligo. All the hospitals in the group are playing a part. Outside the group, our colleagues in Enniskillen and Altnagelvin Hospitals could not have been more helpful, especially so during the Fleadh, which took place in Derry from August 11th to 18th. I would like to personally acknowledge the support from these hospitals and the excellent relationships which bode very well for the future.

Recovery Now that there is an interim ED and radiology service back on site, Letterkenny can resume some functions and schedule elective work which had been put on hold.

In addition, the number of OPD clinics running is increasing every week. The aim is to return all services in the shortest time possible and in some cases in temporary locations while the long term solution is being worked out. The recovery plan for

the hospital is on track. We have appointed a design team to assess what is required to return the hospital to full functionality and although it will be some time before we achieve this, our colleagues in Estates have achieved a huge amount of work in a remarkably short time.

In the meantime let me once again take an opportunity to acknowledge the incredible commitment and hard work of Sean Murphy and his team. There isn’t room to mention all, but they include Paddy Rooney, Deputy GM; Peter Byrnes, Facilities Manager; Dr Anne Flood, Director of Nursing; Dr Paul O’Connor, Clinical Director; Aisling McDonald, Office Coordinator and many more. We plan to hold our next board meeting in Letterkenny during September and we will thank the many agencies, community members and local representatives who have all pulled together during this difficult time and share with everyone our plans to fully restore services.

44 Health Matters

Data Protection

Information and Guidance on Data Protection published The HSE has recently published a number of documents to provide information and guidance for staff in relation to data protection and freedom of information legislation, writes Ray Mitchell, Assistant National Director, Parliamentary and Regulatory Affairs.

T

he health service creates, collects and processes a vast amount of data in multiple formats every day. The security and protection of personal information held by the HSE is of critical importance to both patients and staff – and therefore to the organisation. We have a responsibility to ensure that the personal information we deal with is treated with the greatest possible care and everyone who works in the HSE has a personal responsibility to ensure that this data is not accessed or disclosed inappropriately.

Our obligations in relation to safeguarding personal data and ensuring that an individual can access their own data on request are reinforced by legislation – the Data Protection Acts 1988 and 2003 and the Freedom of Information Acts (FOI) 1997 and 2003. Data protection is about an individual’s fundamental right to privacy and the legislation confers eight data protection rights whether the personal data is held in electronic format or in a manual or paperbased form.

The HSE has a responsibility to ensure that personal data is obtained fairly, recorded correctly, used and shared both appropriately and legally, and stored securely. To assist staff in meeting their obligations and that of the organisation under data protection legislation, the HSE has developed two new guidance documents: A Guide for Staff to the Data Protection Acts 1988 and 2003 and the Freedom of Information Acts (FOI) 1997 and 2003, and HSE Record Retention Periods – Guidance for HSE Staff. These build on the various policies in place throughout the organisation since the introduction of the data protection and FOI legislation and are designed to provide assistance and direction to staff.

Records All staff will, on a regular basis, deal with records that contain personal information – and therefore must be aware of their responsibilities under the Data Protection Acts in particular. The HSE has developed a short but comprehensive booklet, Data Protection – It’s Everyone’s Responsibility, which will be available to all staff and provide specific guidance on what is required of them. It includes practical steps which staff should undertake to protect data and patient privacy. It will be mandatory that all staff read and acknowledge that they understand what is outlined in this booklet.

The HSE’s employee handbook includes inter alia (among other things) induction for all new staff on data protection and freedom of information legislation. The HSE also provides training for staff and we will be continuing to deliver and enhance that training on an on going basis.

Two documents will provide direction to staff should they require it: • A guide for staff to the Data Protection Acts 1988 and 2003 and the Freedom of Information Acts (FOI) 1997 and 2003: This document is based on the eight principles of data protection and in great detail outlines the measures that staff must take to ensure that personal information is collected and stored correctly, shared appropriately, stored safely and disposed of properly at the appropriate time.

Specifically, it provides details of the various types of requests for personal information that staff may be asked to deal with, not just from the individual but from external organisations or agencies such as HIQA, An Garda Síochána or the courts.

• HSE Record Retention Periods – Guidance for HSE Staff: While is it a

fundamental obligation of the HSE to ensure that records are obtained correctly and kept securely, it is equally important to ensure that they are disposed of correctly when it is no longer appropriate to keep them. Staff may sometimes be reluctant to dispose of records and of course, in some instances it is both necessary and prudent to retain them – however, the perpetual retention of all records is in breach of data protection legislation. The HSE has now updated the 1999 policy developed by the former health boards, and sets out clearly the minimum length of time individual records should be retained and provides guidance of the appropriate methods for record disposal.

This guidance will assist staff in their understanding of what is required of them under data protection legalisation and sets a standard that all health service staff can achieve. It is also important to note that should you have a specific query you can also contact your area consumer affairs office – contact details are available at www.hse.ie.

The development and production of these documents has been the result of the work of the Health Service Working Group and in that regard I would like to express sincere thanks to its members for their hard work and commitment. A special word of sincere thanks on behalf of the working group must go to Caitriona Meehan who was the project officer to the group and who efficiently and professionally co-ordinated and edited the documents.

The revised Health Service Data Protection documents and other relevant information can be found on the HSE Intranet (Visit HSE Central, go to Consumer Affairs, click on Access to Information and then Data Protection).

Health Matters 45

Data Protection

Data Protection – It's Everyone's Responsibility A summary guide for HSE staff, Data Protection – It’s Everyone’s Responsibility aims to help HSE staff to understand the regulations and meet the organisation's obligations, as these extracts show.

• Rooms, cabinets or drawers in which personal records are stored should be locked when unattended. A record tracing system should be maintained of files removed and/or returned.

• It is important to ensure that service user and/or staff information is not discussed in inappropriate areas where it is likely to be overheard, including conversations and telephone calls. Particular care should be taken in areas where the public have access.

+ Ray Mitchell, Assistant National Director, Parliamentary and Regulatory Affairs.

Take These Practical Steps to Protect Data and Patient Privacy • Operate a clear desk policy at the end of each working day and when away from the desk or the office for long periods.

• Personal and sensitive records held on paper and/or on screens must be kept hidden from callers to offices/nurses stations/public hatches.

• Records (patient files) containing personal information must never be left unattended where they are visible or may be accessed by unauthorised staff or members of the public.

• If computers or VDUs are left unattended, staff must ensure that no personal information may be observed or accessed by unauthorised staff or members of the public.

• While appreciating the need for information to be accessible, staff must ensure that personal records are not left on desks or workstations at times when unauthorised access might take place.

• Access service user information on a need to know basis and only view or share data that is relevant or necessary to carry out your duties.

Do not leave personal and confidential information/data unattended in cars • Do not leave laptops/portable electronic devices and/or files containing personal information unattended in cars.

• All files and portable equipment must be stored securely. If files containing personal information must be transported in a car, they should be locked securely in the boot for the minimum period necessary.

• Do not take healthcare records home – however, in exceptional cases, where this cannot be avoided the records must be stored securely. Healthcare records

should not be left in a car overnight but stored securely indoors.

Transmitting information by fax or post • Respect the privacy of others at all times and only access fax messages where you are the intended recipient or you have a valid work related reason.

• If you receive a fax message and you are not the intended recipient you must contact the sender and notify them of the error.

• Fax machines must be physically secured and positioned to minimise the risk of unauthorised individuals accessing the equipment or viewing incoming messages.

• Where possible the information should be encrypted and transmitted via email.

Mobile Phones • Users must ensure their HSE mobile phone device is protected at all times.

•A t a minimum all mobile phone devices must be protected by the use of a personal identification number (PIN). Where it is technically possible, the mobile phone device must be password protected and all passwords must meet the requirements of HSE password standards policy.

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• The use of secured screen savers is advised to reduce the chance of casual observation.

46 Health Matters

Data Protection If a lost or stolen HSE mobile phone device contained confidential or personal information, this must be reported and managed in accordance with the HSE data protection breach management policy.

Disposal of Records It is vital that the process of record disposal safeguards and maintains the confidentiality of the records. This can be achieved internally or via an approved records shredding contractor, but it is the responsibility of the service to satisfy itself that the methods used provide adequate safeguards against accidental loss or disclosure of the records.

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Data Protection Breaches If personal data is inadvertently released to a third party without consent, this may constitute a breach of the Data Protection Acts. If you aware of a breach or suspected breach of the Data Protection Act you must: Implement the HSE’s Breach Management Policy There are five elements to any data breach management plan:

• Users must take all reasonable steps to prevent damage or loss to their mobile phone device. This includes not leaving it in view in an unattended vehicle and storing it securely when not in use. The user may be held responsible for any loss or damage to the mobile phone device if it is found that reasonable precautions were not taken.

•M obile phone devices equipped with cameras must not be used inappropriately within the HSE.

• Confidential and personal information must not be stored on a HSE mobile phone device without the prior authorisation of the HSE information owner. Where confidential and personal information is stored on a HSE mobile phone device, the information must be encrypted in accordance with the HSE encryption policy.

•A ll email messages sent from a HSE mobile phone device which contain confidential and/or personal information must be sent and encrypted in accordance with the HSE electronic communications policy.

• Users must respect the privacy of others at all times, and not attempt to access HSE mobile phone device calls, text messages, voice mail messages or any other information stored on a mobile phone device unless the assigned user of the device has granted them access.

•C onfidential and/or personal information regarding the HSE, its employees or service users must not be sent by text message.

• Identification and classification – what information was breached and how sensitive is it?

• Containment and recovery – minimise the damage and retrieve the data if possible.

• Risk assessment – what are the potential adverse consequences of this breach?

• Notification of breach – notify the area consumer affairs office who will, if required, notify the data protection commissioner.

•E valuation and response – aim to establish how the breach occurred and take action to ensure it doesn’t occur again.

•U sers must report all lost or stolen mobile phone devices to their line manager and their local mobile phone administrator immediately.

• Comply with requirements/ recommendations of the data protection commissioner’s office.

• Local mobile phone administrators must report lost or stolen mobile phone devices to their senior manager, the mobile phone service provider and the relevant assistant national director of finance immediately.

Notify the local area consumer affairs office The consumer affairs office can also provide staff with advice, guidance and training on data protection legislation.

Health Matters 47

Clinical Effectiveness

National Clinical Guidelines Improve Health Outcomes The National Clinical Effectiveness Committee (NCEC), established by the Minister for Health, is part of the patient safety initiative which provides information, documentation and links to useful resources and developments in patient safety in Ireland, write Professor Hilary Humphreys, Chair, NCEC; Dr Deirdre Mulholland, Deputy Chief Medical Officer, Department of Health and Dr Kathleen Mac Lellan, Nurse Advisor, Department of Health.

P

atient Safety First is an awarenessraising initiative through which healthcare organisations declare their ongoing commitment to patient safety.

Through participation in this initiative, those involved commit to play their part in improving the safety and quality of healthcare services.

The NCEC was established at the first national patient safety conference three years ago. The chair of the NCEC is Professor Hilary Humphreys, Professor of Clinical Microbiology and Consultant Microbiologist at the Royal College of Surgeons in Ireland and Beaumont Hospital.

“The NCEC will significantly strengthen the evidence base for clinical care, leading to improved outcomes for patients and providing them with reassurance about the quality of their care through evidencebased quality assured national clinical guidelines,” he says.

What is the NCEC? The NCEC is a ministerial committee with representations from a variety of stakeholders including patient representative groups, the Department of Health, the HSE, the Health Information and Quality Authority, professional regulatory bodies, colleges, health insurers and private healthcare providers. Its mission is to provide a framework for the endorsement of national clinical guidelines and audit to optimise patient care through the application of criteria for the prioritisation of guidelines, quality assuring those guidelines that are prioritised and recommending clinical guidelines for ministerial endorsement to become part of a suite of national clinical guidelines.

What are national clinical guidelines?

National clinical guidelines are systematicallydeveloped statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about appropriate healthcare for specific clinical circumstances across the entire clinical system.

The Chief Medical Officer, Dr Tony Holohan, believes that “the implementation of national clinical guidelines can improve health outcomes for service users, reduce variation in practice and improve the quality of clinical decisions”.

Ireland’s First National Clinical Guideline The National Early Warning Score is the first national clinical guideline to be endorsed by the Minister for Health, Dr James Reilly TD. Launching this guideline in February of this year the Minister

said: “I consider this first national clinical guideline: National Early Warning Score an important driver for improving the quality and safety of patient care and as such its implementation is a policy priority for the Irish healthcare system”.

This guideline is specific for adult patients in acute hospitals and is designed to facilitate the early detection and management of patients who are

48 Health Matters

Clinical Effectiveness deteriorating clinically. The guideline was developed through the collaborative work of frontline clinical staff, patient groups and key patient safety experts led by the Acute Medicine Programme of the HSE. The Minister commended the Acute Medicine Programme of the HSE as being to the international forefront in this patient safety initiative and on Ireland being the first known country to agree a national early warning score.

NCEC Symposium, October 17th The NCEC will be hosting a symposium in Farmleigh House, Dublin on October 17th. This symposium will hear from international experts and provide interactive workshops on the various elements for development of clinical guidelines.

The NCEC Work Processes By supporting evidence-based clinical guideline development and audit, the NCEC seeks to support all healthcare practitioners in improving the quality of patient care and in minimising any adverse outcomes. While this requires considerable commitment on behalf of guideline developers to produce guidelines that are fit for purpose and developed in line with best international practice, this ensures that patient care is as good as it can be. Ultimately, this will result in improved service delivery, enhanced professional satisfaction and provide reassurance to the public about the safety and effectiveness of patient care. A sevenstep process for endorsement of national clinical guidelines is in place.

The NCEC recognises that the health system as a whole is likely to be able to effectively implement and monitor only a small number of national clinical guidelines each year and that not all clinical guidelines will be submitted for national endorsement. However, clinical guideline development groups can continue to develop clinical guidelines using evidencebased methodology in response to the needs of their own organisations.

Next Steps Further guidelines are due to be endorsed in the near future and the chair of the NCEC would like to thank and acknowledge the contribution of all

those who have been involved including members of the committee itself, the working group, guideline developers and many others.

Information on the NCEC and resources including endorsed national clinical guidelines are available on the Patient Safety First website at www. patientsafetyfirst.ie. The following documents are available on the site: Framework for Endorsement of National Clinical Guidelines, V4 (2013); Clinical Guideline Developers Manual (2012); Clinical Guideline Screening and Prioritisation Criteria, V3 (2013) and Modus Operandi, V2 (2012).To view the HIQA National Quality Assurance Criteria for Clinical Guidelines (2011) visit www.hiqa.ie.

“The implementation of national clinical guidelines can improve health outcomes for service users, reduce variation in practice and improve the quality of clinical decisions�

Health Matters 49

News // In Brief

Unique Guides Unit Celebrates Fifth birthday Irish Girl Guides (IGG) has just celebrated the Fifth birthday of one of its most unique units – the Crumlin Hospital Girl Guide Unit. The unit for patients of Our Lady’s Children’s Hospital, Crumlin, in + Irish Girl Guides volunteer leaders who celebrated the fifth birthday of the guide unit in Our Lady's Children's Hospital, Crumlin by painting a series of cottages that Dublin, first started in line the hospital corridors.

July 2008 and is the only guide unit in the country to meet in a hospital. who has enjoyed attending guide meetings in the hospital in recent weeks, was well enough Every Thursday evening, female patients to join in the painting for about an hour. who are well enough are invited to participate Róisín Fitzgerald, Co-ordinator of Crumlin in a guide meeting run by volunteer girl guide Girl Guide Unit, said: “To celebrate our unit’s leaders. Like any IGG weekly meeting, the fifth birthday in the hospital we wanted to sessions involve a variety of games, crafts do something that all patients would enjoy, and activities that encourage girls to develop even when we aren’t there. We had a great confidence and a broad range of skills in a fun time painting the cottages with funky colours, and friendly environment. Many of the patients brightening up the corridors. The more artistic enjoy them so much that when they return leaders really enjoyed coming up with the ideas home they join their local Brownie or guide unit. of what characters to paint!”

To celebrate the unit’s fifth birthday, the Geraldine Regan, Director of Nursing and volunteer leaders painted a number of cottages Deputy Chief Executive of Our Lady’s Children’s that line the walls of the hospital corridors. The Hospital paid tribute to the work of the guides: leaders had noticed that the cottages, which “We are delighted to mark the fifth birthday have lined the walls of the hospital since they of the Irish Girl Guides' Crumlin Hospital Unit. were donated by Clery’s 45 years ago, were in Congratulations to the IGG leaders for their need of a makeover. work over the past five years. Activities such Leaders were joined by IGG members in as guides make a very positive difference to their teens and early twenties from Celbridge, our patients and help to relieve some of the who helped paint the cottages bright colours stress and the pressure on children of being and depict cartoon characters peeping out the in hospital.” windows. They were delighted that one patient,

Occupational Safety and Health Seminars The healthcare section of the Institution of Occupational Safety and Health (IOSH) is hosting two events this autumn.

A ‘Risk Management in Healthcare’ seminar will include presentations on risk registers, fire risk assessment, and the Health and Safety Authority’s ‘BeSmart’ online risk assessment tool. This is being held on October 24th.

In addition, on November 14th a sharps safety seminar will focus on how healthcare

organisations can implement the sharps regulations, including a presentation from a member of the HSA. The seminars run from 9am to 1pm each day. Registration is from 8.30am. A fee of a30 will apply to each seminar for nonIOSH members. The venue for both events is the Ashling Hotel, Parkgate St, Dublin 8.

Advance booking is required. For further details contact Tom Madden on tmadden@ coombe.ie or (01) 408 5475.

Tackling Obesity – new booklet now available for parents Eat Smart Move More, a booklet which encourages and supports children to eat well and be more physically active, has been redesigned by community dietitians and the Health Promotion Service in the HSE and is now available on www. healthpromotion.ie.

Originally devised by the Irish Nutrition and Dietetic Institute and the Irish Society for Chartered Physiotherapists, the updated 18 page publication has a clear and attractive layout, and particular attention has been paid during the redesign to ensure ease of readability of the content.

Printed materials can play a useful role in health promotion by providing information on health issues like childhood obesity.

The prevalence of overweight and obesity has increased with alarming speed over the past 20 years. In Ireland today, one in five boys (20 per cent) and one in four girls (25 per cent) are either overweight or obese. Most parents will not recognise this problem in their child. Some 85 percent of parents with an overweight child and 56 per cent of parents with an obese child believe their child’s weight is fine for their age.

The causes and solutions to obesity are complex. Our eating and physical activity patterns are influenced by several things: our own biology, psychology, food marketing, our built environment; and government policies, regulations, programs and practices.

Eat Smart Move More focuses on goal setting and self monitoring and includes a reward chart that can be completed by the child. Copies of the reward chart can be downloaded from www.healthpromotion.ie.

It also includes a meal planner, food labelling information and lots of ideas for getting children active.

50 Health Matters

Commercial Profile

O’Flynn Medical continues to prosper With state-of-the-art premises and notable success in the Irish and UK markets, it is a time of growth for O’Flynn Medical.

O

’Flynn Medical has announced its largest expansion since opening in 2000. Construction on the premises is currently under way and is due for completion in January 2014. The new facility will be one of the largest in the county, with state of the art equipment being installed. The inclusion of a purpose-built decontamination unit will ensure that specialist equipment including beds, air mattresses, hoists and specialist seating is thoroughly cleaned tested and certified prior to and following rental.

Speaking at the announcement, O‘Flynn’s Managing Director Tadhg O’Flynn said that “our recent successes in the health industry will ensure the longterm viability of O’Flynn Medical”. These successes include being awarded the HSE tender for the supply of the Stryker Auto Sure Float high risk pressure care mattress

for the critical care unit in Limerick University Hospital. O’Flynn Medical was awarded this contract following extensive trials on a vast number of mattresses.

One of O’Flynn Medical’s largest successes to date has been the supply of scrubEx and alEx (automated garment dispensers) to hospitals in Ireland and the UK. These systems were introduced to Ireland by O’Flynn Medical in 2010. Both systems maximise the savings potential in the provision of scrubs (scrubEx) and linen (alEx), allowing hospital management to reduce operating costs without compromising on patients’ safety. Both systems provide management reporting software to validate the laundry company’s charges, and up-to-the-minute information and live data on all users, totally eliminating non-returns to the system. The system is widely used in US hospitals.

+ Monica Griffin, Theatre Manager, St. James Hospital explain how scrubEx works to Dr. James Reilly, Minister for Health

Systems have received the stamp of approval from laundry supplies such as Celtic Linen, with the MD of Celtic Linen Philip Scallan stating: “Celtic Linen considers the scrubEx system to be the most significant development in hospital linen service this decade”.

Following their success in the Irish marketplace O’Flynn Medical have increased their portfolio, having acquired the European distribution rights for these unique systems. The UK market has had a huge interest, with the systems already being ordered in high profile hospitals such as St. Mary’s Hospital (London) and Guy’s and St Thomas’ Hospital Trust.

In addition to supplying HSE and privately-owned hospitals/nursing homes, O’Flynn Medical also provides a rental service [via MediRent] to patients who seek specialist equipment to ensure their comfort both at home and away.

The new facility will be one of the largest in the county, with state of the art equipment being installed. The inclusion of a purpose-built decontamination unit will ensure that specialist equipment including beds, air mattresses, hoists and specialist seating is thoroughly cleaned tested and certified prior to and following rental.

Reduce your environmental footprint Enhance infection control Reduce scrub & linen use Reduce costs Control Costs

scrubEx is an automated system that ensures availability and correct use of Medical Scrubs

alEx is a linen automated distribution system which allows authorised users to access hospital bed linen.

Every department and staff member will benefit from using the

scrubex/alex automated systems Benefits include: • Authorised users have access to clean scrubs/linen 24 hours a day 365 days a year via their identification card • Costs associated with non-returns is eliminated • Extensive reporting capabilities enabling management overview of usage and associated costs

John Murphy is the Product Specialist for scrubEx and alEx. He would be delighted to hear from you to answer any queries that you have regarding how your hospital will benefit from the scrubEx and alEx systems.

1890 440 440 087 9269 025 johnmurphy @oflynnmedical.com

52 Health Matters

Quality Improvement

National Quality Improvement Programme To Be Rolled Out The Quality and Patient Safety Directorate has partnered with the Royal College of Physicians to develop the National Quality Improvement (QI) Programme, which is being rolled out to senior healthcare professionals in Ireland.

I

n 2010, the HSE and the Royal College of Physicians of Ireland discussed an idea for building a cadre of healthcare professionals with skills and knowledge in leadership and process improvement techniques. This led to the development of the Diploma in Leadership and Quality in Healthcare, which started in September 2011. It was targeted at all senior healthcare professionals such as clinical directors, clinical programme leads, directors of nursing and hospital CEOs. The first diploma received very successful feedback, with 100 per cent of attendees identifying that they would recommend the diploma to their colleagues and 77 per cent of attendees prioritising quality improvement in their work plan. Due to this success, the Minister for Health Dr James Reilly TD announced the roll out of the National Quality Improvement (QI) Programme. This was supported by Dr Philip Crowley, National Director of the Quality and Patient Safety Directorate with Leo Kearns, CEO from the Royal College of Physicians of Ireland.

The National QI Programme consists of a number of successful components. It aims to improve healthcare in Ireland by giving participants the understanding and tools they need to carry out improvement projects.

The programme aims to build leadership skills and expertise in quality improvement, to develop a common language between management and clinicians and to help them achieve their common goal of improving Irish healthcare. The major elements of the National QI Programme are: • Leadership • Improvement science • Spread and sustainability • Flow • Changing culture • Patient safety

Diploma in Leadership and Quality in Healthcare This programme has been designed to guide senior management and clinicians in leadership and quality so as to improve patient safety within their workplaces.

Three academic years have been held to date and over 100 healthcare professionals have participated. Participants undertake a year-long quality improvement project in the workplace. These projects have had significant impact on patient safety, patient flow and patient experience such as reducing wait times and improving access for patients.

Senior Leadership Training Senior leadership training was held with hospitals such as Tallaght Hospital, St James’s Hospital and the Children’s University Hospital, Temple Street.

The participants worked on quality improvement projects within their hospitals.

Nurse Leadership Development Programme Working with the National Leadership and Innovation Centre for Nursing and Midwifery, a joint leadership programme for clinical nurse managers in medicine from the Mid-Western Hospital Group was developed. As part of this programme, the fundamentals of quality improvement are being delivered by focusing on a single area of improvement.

In this instance the topic is ‘reducing harm from falls’. This is a collaborative approach whereby multidisciplinary teams come together to identify the best practice by applying improvement methods. Teams report results and share information about ways of achieving improvement in their particular workplace.

Each component of the National QI Programme has had significant results and some of these results will be highlighted in following issues of Health Matters to demonstrate the continued work of healthcare professionals in improving quality and safety in the health system.

“The National QI Programme consists of a number of successful components. It aims to improve healthcare in Ireland by giving participants the understanding and tools they need to carry out improvement projects.”

Health Matters 53

Arts in Health

Let’s Connect Artwork that helps us feel connected provided the background to an exciting exhibition hosted at the Dunamaise Arts Centre, Portlaoise and curated by HSE Clinical Nurse Specialist Angela Delaney of the Laois Mental Health Services this September.

T

he exhibition, titled Let’s Connect, explores the significant connections between art and mental health, the power that art can play in shaping ideas and how it provides a strong medium to communicate for people who sometimes struggle to engage with society.

It provides a unique opportunity to exhibit artwork by people from different backgrounds such as established artists and mental health service users, and serves as a platform to normalise the experience of mental health illness and prevent stigmatisation and the exclusion of people who are ordinarily on the margins of society.

In her work as clinical nurse specialist in art therapy interventions, Angela Delaney says the power of these-community driven initiatives should not be underestimated.

“By coming together as a community we are highlighting the importance of taking care of our mental health, through engaging with each other and encouraging participation in activities in our local community,” she explains.

“These initiatives promote socialisation and help remove some of the stigma around mental health illness that continues to exist but is thankfully changing.

“Art therapy is about encouraging and supporting people who experience mental health problems to use their strengths and interests in art as a tool in their recovery.

Artists' Response “It’s a great sense of achievement to see my art framed and on display.”

“I was no good at anything when I was in school but I must be good at art now as my picture is up on the wall.”

“When I create art I feel I can do anything.

Some people just see me as a patient but I’m more than that.”

+ Dolores Hartford, Margaret Dunican, Adrian Mulhall, Angela Delaney (Clinical Nurse Specialist) and Monica Condron, who participated in the arts exhibition hosted at the Dunamaise Arts Centre, Portlaoise.

Some of these artists desire to exhibit and sell their art like established artists, but due to circumstances have difficulty accessing exhibiting opportunities. As citizens these artists should have the same rights as everyone else.”

There is no doubt that art therapy has provided the clients in the mental health services of Laois and Offaly with a profound sense of self and community, some of the contributors have described their feelings in advance of the exhibition (see panel).

The artists Among the established and internationallyacclaimed artists exhibiting at the Let’s Connect event is Brian Maguire, a Wicklow-born expressionist painter dealing with themes of physical and political alienation by focusing on marginalised and disenfranchised groups.

Geraldine O’Reilly is a native of Westmeath who works in the medium of painting, drawing, print making and photography and focuses on recreating landscape. She was honoured for her contribution to the arts in 2004 when she was elected a member of Aosdána. Éilis Crean was born in Dublin and is currently living and working as associate professor of art at the University of West Georgia. She divides her studio time between Georgia, the USA and Ireland. Her work has been exhibited around the world

and is held in the state collections of Ireland, France, Latvia and the United States. While working in a variety of media she will exhibit paintings from her Votive Series depicting hopes and desires as well as offering opportunities for contemplation and renewal.

And finally, the exhibition will also have work

by Niamh Boyce, artist, novelist and poet who is from Athy, Co Kildare. Her artwork has been chosen for Eigse and exhibited in arts centres in Ireland. Her novel The Herbalist was recently published by Penguin Ireland.

She won the Hennessy XO New Irish Writer of the Year in 2012 for her poetry. Her fiction has been shortlisted for awards such as the Francis Mac Manus, the Molly Keane Award and the 2009 New Irish Writing Award.

The exhibition will form part of Laois Mental Health Awareness Week, Laois Connects, from September 28th to October 5th. In addition to the exhibition, Angela Delaney, CNS in Arts Therapy Interventions, will also host a free workshop on September 30th with Niamh Boyce (writer and artist): Mark My Words, a session focused on positive mental wellbeing, will provide a supportive, friendly environment for people to be creative while art making and writing in the Dunamaise Art Centre, Portlaoise, Co. Laois. Booking is essential and people interested should contact (057) 866 4107.

For further information visit www.laoiscommunityforum.ie/laoisconnects.

54 Health Matters

Quality and Safety

Quality Assessment and Improvement Resources Launched The new guide, workbooks and web-enabled tool are an initiative of the Quality and Patient Safety Directorate.

T

he National Standards for Safer Better Health Care launched by the Minister for Health in June 2012 relate to all healthcare services (excluding mental health). The development and implementation of the standards are elements of a programme of initiatives – Patient Safety First – which is focused on raising awareness of and driving improvements in patient safety and quality of healthcare.

Quality Assessment and Improvement (QA+I) Launch The HSE Quality and Safety Directorate (QPSD) has recently launched QA+I resources to support acute hospitals in assessing themselves against the National Standards. These resources comprise of: (i) a practical guide (ii) a series of eight workbooks which complement (iii) a web-enabled QA+I tool.

Translating the National Standards In developing the QA+I resource, each of the national standards was translated into Essential Elements of Quality which are practical, specific, tangible quality outcomes; these provide greater clarity and focus for service providers as to what they can expect to see in their service following implementation of the national standards.

Four levels of quality for each essential element were developed. The draft tool was made available for public consultation.

To further ensure that the final tool was fit for purpose, it was tested with a number of hospital management and clinical directorate teams.

Getting on the Quality Continuum Given that the National Standards for Safer Better Healthcare are relatively new to the healthcare system, it is recognised that

+ Pictured at the launch of the QA+I Resources were (L-R): Dr Philip Crowley, National Director for Quality and Patient Safety; Phelim Quinn, Director of Regulation, HIQA; and Dr Mary Browne, QPS Lead for QA+I.

implementing these standards may be challenging and require significant effort by services.Therefore, a guiding principle of the assessment is to create a process of continuous quality improvement, progressing towards full implementation.

Verifying your Selected Level of Quality A list of examples of evidence is provided within the QA+I tool to support hospitals in verifying their selected level of quality for each essential element.This list is intended as a guide and services can add in additional evidence that better supports their selected level. The tool also contains an ‘additional information’ section that allows services to provide context and rationale on the selected level of quality for each essential element.

Quality Improvement Plan The key output of the assessment process within the QA+I tool is the development of a quality improvement plan. Following assessment of each essential element, agreed actions to improve quality will be recorded in this improvement plan. The plan is then implemented and monitored through governing arrangements within each

“This tool places patients at the centre, will be of great benefit to hospitals, and ultimately build on our common drive for improvements in quality healthcare.” individual hospital. Following completion of the first assessment, the focus will be on implementing and monitoring progress of the quality improvement plans, with progress reports being developed and submitted to governing committees every quarter.

Assessment Reports The QA+I tool has the capacity to develop assessment reports for each assessment team. The report includes analysis of the results from the assessment. At a glance, assessment teams will be able to determine the areas requiring focused and targeted effort by the service.

Health Matters 55

Quality and Safety Developing the QA+I resources QPSD formed a national standards implementation team to plan and lead the process and develop the support mechanisms. The Safer Better Healthcare – Acute Care Collaboration (co-chaired by Dr Mary Browne and Cornelia Stuart) was established to facilitate the development of this approach within the acute sector.

Membership of the collaboration included representation from frontline services, voluntary hospitals, independent hospitals and regional quality and patient safety teams. The collaborative received advice and direction from the Quality and Patient Safety Steering Group which is chaired by Dr Philip Crowley.

At each stage, the plans and development of QA+I was shared with the Health Information and Quality Authority (HIQA) to ensure that it met their regulatory requirements.

At the launch, Dr Mary Browne said: “I would like to thank everyone from the collaboration for their motivation and insight in creating the QA+I approach. It is great that this tool is now available to

facilitate assessment within acute services.

Information collected within the QA+I tool will support services in levering quality improvement

Using the QA+I tool To support the standards assessment process within hospital, regional standards support groups have been set up within each of the four regions. These will be aligned to governance changes as a result of the recent announcement of the establishment of the Health Service Directorate, service divisions and hospital groups. At the launch, Dr Philip Crowley described the resources as “creative, positive and constructive, which adopt a simple, user-friendly logical approach to levering quality improvements through the national standards”.

The QA+I resources are available on the HSE website at www.hse.ie/go/qps. For further information on the QA+I electronic tool contact mary.browne7@hse.ie

Dr Philip Crowley described the resources as “creative, positive and constructive, which adopt a simple, userfriendly logical approach to levering quality improvements through the national standards”.

QUALITY ASSESSMENT & IMPROVEMENT

56 Health Matters

News // In Brief

New School for Limerick Hospital Contracts have been signed for the building of a new a320,000 school in University Hospital Limerick, which will incorporate the latest in information technology and cater for the continuing education of children who are patients in the hospital.

The original school opened in 2006 and was the brainchild of paediatrician Dr Liam Carroll. He believed it would help to provide for the holistic treatment of children in hospital and help normalise their stay.

The school is governed by a board of management which is very supportive of the new project. Dr Carroll, now retired, has given very generously of his time and talents to the project. Frank Keane, Directorate Manager, Maternal and Child Health, has now taken over as chairperson.

The school principal is Margaret McCarthy and she is supported by Mary Carr. Teachers in healthcare settings

Bands Perform at the Áras Members of the National Ambulance Service Pipe Band from Cork attended Áras an Uachtaráin to perform for President Michael D Higgins at a special function in July. The band comprises of serving and retired paramedics from the ambulance service.

They were joined by colleagues from the National Ambulance Service Pipes and Drums. Both bands have played together to a wide range of audiences and events.

Before the performance Barry Hayes, Chairman of the band committee, presented the president with a piece of Galway Crystal specially engraved for the occasion.

+ Dr Roy K Philip; Maura Fitzgerald, Deputy Matron; and Professor Pierce Grace at the signing of the contract for the new school.

must be registered members of the Teaching Council and are regulated by the Department of Education and Skills.

The national curriculum and associated

methodologies and resources, including communication technology, are implemented appropriate to the individual needs of the child and young person.

New Medical Assessment Unit Opens at Mallow General Hospital The newly-built Medical Assessment Unit (MAU) at Mallow General Hospital opened in September, replacing a temporary facility that it had been operating since March.

The new eight-bed unit is open seven days a week (8am to 8pm), treating patients suffering from a recent onset of symptoms such as breathlessness, chest pain or blackouts. The unit only accepts patients referred by their GP or Southdoc to ensure + Nursing staff preparing for their first patient in that only patients suitable for treatment Mallow General Hospital’s newly opened Medical present.

Assessment Unit, L-R: Aisling McGoldrick and Within an hour of arrival patients referred to Mairead Pendle, Staff Nurses; Mary Owens, Director of Nursing; Adrian Higgins, CNM2 and Karen Breen, the MAU are seen by a senior doctor who has Staff Nurse. ready access to diagnostics such as x-rays, blood tests, scans, etc. The MAU is staffed by consultant physicians, nurses, healthcare assistants, dieticians, administrators, caterers and housekeepers.

The clinical lead is Dr Ceara Harte, general physician with a special interest in cardiology, who is supported by Dr Cornelius Cronin, general physician with a special interest in gastroenterology; Dr John Kiely, general physician with a special interest in respiratory who started this April and the newly-appointed geriatrician Dr Ciara McGlade. Adrian Higgins, CNM2 is the lead nurse in the unit.

Dr Harte said: “The opening of the new unit has multiple benefits for patients. Medical assessment units facilitate early diagnosis and initiation of appropriate treatment. This results in patients being discharged earlier, a reduction in the volume of medical admissions and a shortening in the length of time patients spend in hospital. Southdoc/GPs can also admit medical patients directly to the hospital outside the MAU’s opening times.”

Research Opportunities for Health and Social Care ProfessionALs Are you a health and social care professional with several years’ clinical experience?

Do you have a research idea that could improve patient care?

If so, you may want to apply for a Health Research Board Research Training Fellowship for Healthcare Professionals 2014.

• This funding initiative supports outstanding health and social care professionals, who have the potential to develop as research leaders in their area of expertise, to complete a PhD. • The topic must focus on health services, patient-oriented or population health research, and should generate knowledge and evidence that is of benefit to people’s health.

• Support is offered on a full-time or part-time basis.

From 2013, four additional professions are eligible to apply.

• Audiologists • Clinical Engineers • Medical Physicists • Clinical Measurement Scientists

The following professionals are also eligible to apply.

• Clinical Biochemists • Dentists • Dieticians • Health Psychologists • Medical Practitioners • Medical Scientists

• Nurses and Midwives • Occupational Therapists • Orthoptists • Pharmacists • Physiotherapists • Podiatrists/Chiropodists

• Radiographers • Social Care Workers • Social Workers •S peech and Language Therapists

For further information please contact: Margaret Devitt e: mdevitt@hrb.ie t: + 353 1 2345185 All grants are advertised on the HRB website at www.hrb.ie/grants Sign up now to receive an e-mail every time a new grant call opens at www.hrb.ie/about/rss-e-mail-alerts/

Better Research • Better Health • Better Care

58 Health Matters

Plastic Surgery

Meet the GUH Plastic Surgery Team The Plastic Surgery Procedure Unit (PSPU) at Galway University Hospitals recently celebrated its first birthday.

Since opening last year the unit has reduced HSE West waiting list times for procedures such as soft tissue and digital nerve repairs, laser surgery and surgery on benign and malignant skin lesions.

T

he facility is managed by Staff Nurse Clodagh Hickey, who ensures that there is a smooth transition for the patient from admission through to discharge. The unit opens four half days at present, from Tuesday to Friday, and is located on the third floor of the main university hospital block, adjacent to the intensive care unit.

The PSPU consists of three rooms: an assessment/recovery room, the main procedure room and a kitchenette. There is also a seated waiting area within the unit.

In its first year of operation, the unit attended to over 1,600 patients. Trauma cases are dealt with in the mornings and elective cases are carried out in the afternoons, while laser surgery takes place once a month. All procedures are done under local anaesthetic and this allows for a 'same day' service. Patientcentred care is a priority in the unit and in order to continually improve its healthcare delivery, the team actively encourages and welcomes feedback. At present there is a range of services available at the unit, including laser surgery and the treatment of trauma cases, as well as elective admissions and direct access.

The PSPU is consultant-led, with all four plastic consultant surgeons involved: Mr A Hussey, Mr P Regan, Ms D Jones and Mr Kelly. The unit is also supported by three specialist registrars, Dr J Martin-Smith, Dr K Cahill and Dr Kennedy; three registrars, Dr C Joyce, Dr N Mahon and Dr C Sugrue; two senior house officers, Dr S Murphy and Dr E Concannon; and two interns, Dr M McAllister and Dr R McGrath.

Patients are referred by their GP, seen in the outpatient department and then, if necessary, booked into the unit to attend for surgery. Trauma patients are initially assessed in the emergency department, and if they are deemed suitable for surgery

+ L-R: Dr James Martin-Smith, SPR; Dr Cormac Joyce, Registrar and Dr Robert McGrath, Intern.

they can then directly proceed to the unit. Patients are facilitated through a direct access medium where they will be seen, treated and discharged home with written instructions on aftercare and any subsequent follow-up. This has helped to reduce numbers and waiting times for the emergency department. The unit can take referrals from other hospitals within the Galway and Roscommon University Hospital group, as well as directly from GPs. In certain cases, the unit also takes referrals from the outpatient department, allowing for a 'see and treat' service.

This is only at a consultant’s request for patients needing urgent attention.

Laser Surgery Some 248 patients underwent laser surgery for conditions such as capillary haemangioma, telangiectasia, spider naevi, vasculititis and hiritusim. Some 309 trauma patients have been treated to date, covering a wide variety of soft tissue and bone

“Over 1,330 patients have had surgery for various cutaneous lesions, including common skin cancers such as melanomas and basal cell carcinomas. Surgical techniques include incisional and excisional biopsies, punch biopsies, shave excisions, skin grafts and local flaps.�

Health Matters 59

Plastic Surgery

+ L-R: Dr Maeve McAllister, Intern; Dr Stephen Murphy, SHO; Clodagh Hickey, Staff Nurse; Dr Conor Sugrue, Registrar and Dr Ann Marie Kennedy, SPR.

injuries. The team attends to digital nerve repairs, terminalisation of fingers, repair of lacerations, extensor tendon repairs and debridement and wash-out of wounds.

Non surgical-procedures include the use of sub-cutaneous and intra-lesional injections. Medication such as botox and steroids are given to treat hyperhidrosis and hypertrophic and keloid scars respectively. Xiapex, which is a relatively new medication, is used to inject into Dupuytren’s cords; this enzyme targets and breaks down the contracture, which is manipulated under local anesthetic and released within 24 hours of treatment.

The majority of work carried out is on benign and malignant skin lesions.

Over 1,330 patients have had surgery for various cutaneous lesions, including common skin cancers such as melanomas and basal cell carcinomas. Surgical techniques include incisional and excisional biopsies, punch biopsies, shave excisions, skin grafts and local flaps.

At times, major theatre has been unable to accommodate the large numbers of cases presenting and the PSPU has been able to assist with certain cases, allowing patients to have their surgery and avail of

a faster discharge. The unit has also been invaluable in enabling the team to attend to patients already in hospital. Although present for a different ailment, incidental tumors have been discovered and these patients can have surgery and return to their ward to continue the treatment for which they were originally admitted.

Weekly journal clubs and monthly teaching sessions are integral parts to improving the service, allowing all staff members to keep up to date with advances in plastic surgery. This enables the team to deliver optimum care to its patients, and maintain an environment where clinical excellence can flourish. Clinical audit is also performed regularly to review and refine clinical practice.

The plastic surgeons are continually involved in research, and several innovative projects involving the unit are ongoing.

The Plastic Surgery Procedure Unit has entered its second year as an established department and the team is currently making plans for further development.

Discussions are also taking place to increase the opening hours, making the unit full time and allowing the team to increase the numbers of patients it treats in the coming years.

“Weekly journal clubs and monthly teaching sessions are integral parts to improving the service, allowing all staff members to keep up to date with advances in plastic surgery. This enables the team to deliver optimum care to its patients, and maintain an environment where clinical excellence can flourish.�

60 Health Matters

News // Dublin north east Minister Reilly turns the sod on new Virginia extension In June the Minister for Health Dr James Reilly TD turned the sod on the new extension to the Services for Older People Residential Unit at Virginia Community Heath Centre.

The project involves the construction of a new two-storey extension to the + HSE staff and public representatives pictured with the Minister for Health, Dr James Reilly TD, at the turning of the sod on the new extension at Virginia Community Health Centre. front and sides of the existing centre, which given the complex nature of the project and based on the 'Places to Flourish' model. will provide 26 single en-suite bedrooms, it could only have been made possible by Martin Collum, HSE Area Manager Cavan sitting areas, dining areas, storage and staff the co-operation of the management and Monaghan, said: “The design team was facilities. In addition there will be internal nursing staff of the facility. Their insightful appointed in late August 2012, and in the alterations and demolitions to the existing contributions will in time result in a facility intervening nine months this project has ward areas. On completion the facility will which will deliver state-of-the-art residential been brought from concept stage through have a total number of 50 bedrooms which accommodation to the people of Virginia and to contract award and commencement will be fully HIQA compliant. The project surrounding areas.” on site. This is a remarkable achievement will result in a specifically designed building

Cardiac arrest survivor says thanks to NAS Early this year National Ambulance Service (NAS) staff Alan Kennedy and Stephen O'Neill, both based at Dunshaughlin Ambulance Station, responded to a collapse call in Dunboyne, Co Meath.

The NAS arrived at the scene within 11 minutes of receiving the call where CPR was being attempted on the patient, Gary Clarke, by some of his friends. The paramedics assessed the patient and continued resuscitation for approximately 25 minutes, during which full advanced life support care was carried out. While on the scene they were successful in restarting the patient’s heart on two occasions.

The patient was transported to Connolly Hospital Blanchardstown with the assistance of a second paramedic crew who responded from the Navan Station.

Mr Clarke, who spent four weeks in hospital before being discharged home, has since called to the station in Dunshaughlin with his wife to thank NAS staff for saving his life. He now has a new granddaughter who was born a couple of days after his cardiac arrest.

Community Mothers Programme Recognised by European Commission The Community Mothers Programme (CMP) was first started in 1988 in Dublin, and now operates in the Dublin North East and Dublin Mid-Leinster regions. It is a parent support programme in which local women known as ‘community mothers’ carry out monthly visits to first-time parents living in their own community during the first year of their babies' lives. Community mothers are volunteers who are guided and supported by specially trained public health nurses known as family development nurses.

The aim of the programme is to develop + Community Mothers Programme family Amy and Ellie. the skills of parents of young children with a focus on health care, nutritional improvement and overall child development. In 2012 the programme was delivered by 127 community mothers to 1,136 families.

In recent months the CMP has been included in the ‘practices that work’ section of the EPIC (European Platform for Investing in Children) website, www.europa.eu/epic. The EPIC is an online evidence-based platform which is managed by the European Commission and aims to provide information about policies, practices and programmes that can help children and their families with the challenges that exist in the current economic climate in Europe.

For further information contact Brenda Molloy, Director of CMP. Tel: (01) 838 7341, email: brenda.molloy@hse.ie.

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Dublin north east // News

BEAUMONT OFFICIALLY OPENS NEUROLOGY DAY UNIT In July a new Neurology Day Unit was officially opened at Beaumont Hospital. The unit will treat chronic and ambulatory neurology patients, allowing for easier and more timely access to services as well as reducing the + Dr Sinead Maguire, Neurology Registrar/NDU Project Manager; Marie Keane, number of neurology Deputy CEO; Jennifer Hedderman, CNM2 Neurology Day Unit and Professor Orla Hardiman, Consultant Neurologist, pictured at the official opening. patients attending the hospital’s emergency department. The unit will provide a needs where possible. This unit will benefit follow-up service for patients attending the ED the National Neurology Programme, Epilepsy with seizures and is a key component in the Care Programme, and will help to reduce development of nurse-led services. unnecessary admissions, which is beneficial to all.”

Professor Orla Hardiman, Lead Consultant in Neurology said: “through innovative, proactive In addition to those with epilepsy, the unit will and creative thinking we have developed a also provide a service for people with headache new service that will help us towards our goal and those with neurological symptoms requiring in providing quality care for neurology patients short day procedures including lumbar puncture in a more efficient manner. As one of the and infusion-based treatments. The unit is national centres for neurology it is important expected to treat 636 patients each year, saving that we strive to adapt and respond to evolving over 1,000 patient bed days per annum.

‘Waist’ disposal programme at Our Lady of Lourdes Hospital Over 30 staff at Our Lady of Lourdes Hospital in Drogheda recently completed a six week programme entitled Waist Disposal.

The idea for the programme came from Rose Byrne, Health Promotion Manager.

Rose said: “Earlier this year a large number of staff had taken part in a healthy lifestyle challenge, the Biggest Loser, and many were keen to keep up the momentum of keeping fit and healthy. As part of my work I attend regular hygiene meetings where the issue of disposing of ‘waste’ correctly is always on the agenda. So I came up with the idea for a new challenge for staff to dispose of inches off their ‘waist’ in time for summer.”

Information and guidelines from the Irish Heart Foundation (IHF) were used and the physiotherapy department provided advice on appropriate exercises to help shed the inches. According to the IHF, a

+ Paediatric nurse Connie Crehan, one of the Waist Disposal participants who also took part in the Biggest Loser challenge, is pictured having her waist measurement taken by Rose Byrne, Health Promotion Manager.

healthy waist measurement for women is less than 80 centimeters (32 inches) and for men 94 centimeters (37 inches). If you are overweight, it is where your body stores the extra fat that is the problem. Extra fat around the waist is linked with a higher risk of heart disease, diabetes and some cancers. Nine staff members alone lost over five stone in weight over the six weeks!

Foster carer from Baldoyle wins Dublin Mum of the Year 2013

+ Kathleen O’Farrell pictured with her award for Dublin Mum of the Year 2013.

Foster carer Kathleen O’Farrell from Baldoyle was recently crowned Woman’s Way and Lidl Dublin Mum of the Year after being nominated by her daughter Kathleen junior.

Her daughter said: “While my mother had six kids of her ‘own’, there are more than 60 foster children who have called her "Mam" at some stage. One is now 19 and has been long-term fostered by Mam and Dad, having first come into their care at just 10 months old. One of the most challenging fostering cases was last summer when they were asked to take a new born baby who was not expected to live past a few days. The decision was an easy one for Mam, even being in her 60s and not being as fit as she used to be. She could not bear the thought of this helpless little baby dying in the arms of a nurse or in hospital alone. She even postponed her own 60th birthday present of a trip to Poland to care for the baby. This baby defied all the odds, confounded the medics and has now celebrated her first birthday.”

Maurice Murphy, Fostering Team Leader, Social Work Department, Dublin North said: "Kathleen is such a deserving winner – she has been a wonderful 'mum' to so many children over more than 25 years. Becoming a foster carer is a hugely rewarding experience and when foster carers open their hearts and homes, like Kathleen and her husband, they literally change children's lives for the better."

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News // Dublin north east Achievement Awards for Clients of St Joseph’s Intellectual Disability Service Some 38 clients from St Joseph’s Intellectual Disability Service Portrane were recently presented with achievement awards following their completion of the ASDAN (Awards Scheme Development and Accreditation Network) Towards Independence Programme.

This was the third ASDAN awards ceremony to take place in St Joseph’s Intellectual Disability Service at the Knockamann Resource Centre.

A large number of invited guests and staff were present to witness the joyous occasion.

The presentation ceremony was particularly momentous for the parents, siblings and close family friends who witnessed their loved ones receiving accreditation for their hard work.

Caroline Coakley, Services Manager and co-ordinator for ASDAN, presented certificates to each of the clients. Speaking during the presentation ceremony, Eileen Kelly, Director of Nursing at St Joseph’s Intellectual Disability Service, said: “On behalf of all the staff, I’d just like to say how immensely proud we are of each candidate’s achievement in completing this programme.”

The ASDAN Towards Independence Programme presents a framework of activities through which personal, social, communication and independent living skills are developed and accredited. It offers a flexible programme to meet the needs of those with a wide range of abilities, including the opportunity for formal recognition of small steps of achievement on the path towards larger goals.

+ L-R: Caroline Coakley, Service Manager, North Dublin Mental Health Services; client Louis Carrick with his ASDAN award, and Eileen Kelly, Director of Nursing, St. Joseph’s Intellectual Disability Service.

Airport Police Attend Suicide Alertness Seminar

+ Members of the Dublin Airport Police and Fire Service with SafeTALK tutors Roisin Lowry, HSE and Louise Nolan, Fingal Leader Partnership.

Members of the Dublin Airport Police and Fire Service (DAPFS) attended a half-day SafeTALK training seminar on how to handle potentially suicidal passengers. The training was organised in response to a recent incident at the airport which six members of the airport police dealt with.

The training was provided by Roisin Lowry, Resource Officer, Mental Health Promotion and Suicide Prevention, HSE Dublin North East and Louise Nolan, Youth Mental Health Promotion Officer, Fingal Leader Partnership. Ciaran Grant of DAPFS said that “airport police increasingly find themselves responding to mental health, distress and depression issues in the course of their daily duties. This had culminated in a recent near suicide case at the airport. We enlisted the support of the HSE in an attempt to provide members with the necessary skills to deal with these kinds of situations.”

SafeTALK training is available to anyone over 18 years including teachers, community, youth and voluntary groups. For further information contact the HSE Health Promotion Department on (01) 897 6179.

CAWT Citizenship Project: Doing it Differently “Volunteering has given me the confidence and belief in myself that I can do the job. It has made me happy and I feel part of the team.”

These were the words of Brendan Carroll from Dundalk, a volunteer at the Dundalk Stadium, who spoke at the Doing it Differently citizenship project, a best practice event held in Newry recently.

Jointly hosted by the HSE and the Southern Health and Social Care Trust, the event is part of an innovative cross-border programme which is enabling people with disabilities to participate more actively in all aspects of community life.

Anne Melly, Disability Specialist, HSE Dublin North East said: “I am delighted that the HSE in Louth, Cavan and Monaghan is offering enhanced services to people with disabilities. This project has supported us to fundamentally change our approach to the delivery of traditional day services. It has assisted us to link our service users to a variety of social, leisure, education, and

+ L-r: Sara Blackmore, Community Link Worker, HSE Louth; Brendan Carroll, Project Participant and Emma Meehan, Manager, Dundalk Stadium.

employment opportunities, thus enabling genuine citizenship based on enhanced choice and access for people with disabilities.”

Since 2010, over 500 people aged between 18 and 64 years have benefited from the project and include those with learning, physical and/or sensory disabilities. Funding for the project has been provided by the EU’s INTERREG IVA programme, secured by the Co-operation and Working Together (CAWT) citizenship project.

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Dublin north east // gallery

+ Two children from St Patrick’s Schools in Skerries are pictured with Kevin Connell, client of HSE Lusk Community Nursing Unit, Services for Older People, playing the fiddle. The young fiddlers were part of a group of 12 students who were on their annual visit to the unit where they entertain the clients. The children were mesmerised when Kevin, who is 93 years old, produced his own fiddle and gave them their very own master class. Kevin taught himself to play the fiddle over 70 years ago and regularly brings it along to his Thursday day care group to entertain clients and staff.

+ Professor Doiminic Ó Brannagáin, Consultant in Palliative Medicine, Clinical Director, Specialist Palliative Care and Professor Conor Egleston, Consultant Physician in Emergency Medicine at Our Lady of Lourdes Hospital in Drogheda, who were recently awarded honorary professorship by Royal College of Surgeons in Ireland (RCSI). The award was given by the President of the RCSI in recognition of their contribution to RCSI teaching.

+ At the announcement of the commencement of works to establish a new adult and paediatric outpatient clinic rooms for patients with cystic fibrosis (CF) at Cavan General Hospital are (L-R): Rita Cullen and Bernie Walsh, Respiratory Nurse Specialists; Damien O’Reilly, A/Maintenance Manager; Evelyn Hall, Clinical Business Manager; Dr James Hayes, Respiratory Physician; Rosaleen Cronin, Treasurer and Raymond Dunne, Chairperson, CF Cavan Branch; Gerry Tully, Estates; Lorraine O’Neill with daughter Mia and Niamh Bolger. A joint initiative between Cavan Monaghan Hospital and the Cavan branch of CF Ireland, the units will provide a separate designated area for patients to receive their care and reduce the risk of cross infection.

+ Pictured at a recent CAWT Social Inclusion Project event (l-r): Jim Lennon, Middletown Centre for Autism; Dr Wilhelm Freiherr von Hornstein, HSE Cavan Monaghan; Paul Cavanagh, Health and Social Care Board. Seated: Mary Haughey, CAWT Social Inclusion Project. The project, which is part of CAWT’s Putting Patients, Clients and Families First initiative funded by the EU’s INTERREG IVA programme has delivered a range of health improvement programmes to a total of 3,000 people across the border region, including over 800 people from the Monaghan, Castleblayney and Dundalk areas. The project has been successful in reaching out to those living in socially deprived areas, people with disabilities, ethnic minorities and vulnerable families and women.

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News // Dublin mid-leinster

Unique and Effective Programme for Parents and Babies A unique parenting course which involves the State and community helping to deliver what parents really want for themselves and their young children is proving to be very popular. Frances Fitzgerald, Minister for Children recently joined parents, babies and public health nurses to mark the success of the Up to 2 programme, which is adding value to the antenatal and infant support work carried out by community nurses.

For the first time, Up to 2 overlays proven parenting methods from the Incredible Years strategy on the work that is being carried out by public health nurses.

The Up to 2 programme in Clondalkin/ Lucan is the first of its kind to be rolled out, in full co-operation with PHNs. It consists of three components: antenatal (three sessions), parents and babies (eight sessions over 16 weeks; two hours per session) and parents and toddlers (eight sessions over 16 weeks; two hours per session).

The programme provides a continuum of support, delivered in a group setting, from pre-birth to the toddler years. This means that parents, children and the nurses themselves are deriving far more benefit out of the HSE ante and post-natal support structures that are already in place.

Up to 2 is supported by the HSE Health Promotion Department. Fergal Fox of the Health Promotion Department says that his department was happy to provide funding and support to such a progressive

programme.

Catherine Shanley, a public health nurse said the Up to 2 programme had enhanced their work in the Clondalkin/Lucan area. She is one of eight public health + Public health nurses delivering the unique Archways Up to 2 programme, nurses trained in photographed at a celebration of the initiative with Minister for Children Frances Incredible Years and Fitzgerald TD. L-r: Anne O’Neill, Mabel Murtagh, Valerie O’Brien, Frances running the Up to Fitzgerald TD, Minister for Children; Frances McHugh, Jacqui Guiry, Archways Up to 2 Co-ordinator; Marti Davis, Nora Slevin and Catherine Hanley.

2 programme. The others include Anne that Up to 2 should now be expanded to O’Neill, Mabel Murtagh, Valerie O’Brien, HSE areas throughout the country so that Frances McHugh, Marti Davis, Nora Slevin it becomes the expected norm for Irish and Anne-Marie Linehan. parents. The costs of training public health “This programme is designed around nurses in the Incredible Years strategies is listening to parents and helping them come minimal but the benefits are proving to be up with their own solutions,” says Catherine. huge, according to Aileen O’Donoghue, She believes the key benefits for PHNs Chief Executive of Archways. are that it enhances their practice working “Up to 2 is definitely adding value to the in the community and helps change their state’s support system for parents who are way of dealing with parents from delivering either expecting or just had a child.” information to working with parents to find The programme is also being delivered their own solutions. The programme also at Ballyfermot/Palmerstown Primary Care proves to be less demanding on the drop-in Centre, Rowlagh Health Centre, Rosse PHN clinic, provides regular interaction Court Health Centre, Lucan Health Centre, with parents and babies and allows for the Boot Road Health Centre, Deansrath Health development of skills over time.

Centre and Deansrath Family Centre and Archways, the first organisation to Healthy Living Centre, Clondalkin. introduce Incredible Years to Ireland, believes

Free summer community-based health promotion programmes in Longford A series of positive mental health promotion seminars were held in Longford this summer.

The Longford Acorn Project in partnership with the HSE Health Promotion Department provided free community-based programmes for adults and young people which were part funded by the ESB. The aim of the partnership was to encourage positive mental health promotion and the fostering of resilience in the community.

The programme included topics on positive mental health (Taking Control and Raising

Boys for Fathers), suicide awareness (ASIST and Safetalk), stress control classes, nutrition with HSE community dietitians and parenting (Triple P Positive Parenting).

Fergal Fox, HSE Health Promotion Manager DML said: “The programme was specifically designed to appeal to the entire community as everybody has a part to play to promote positive mental health and there are skills that can be developed so people can help each other and those in crisis. The Acorn Project is providing strong community leadership by

+ The HSE Senior Clinical Psychology Team (L-R ) Ryan O’Neill, Niamh Clarke, Carmel Breaden (Principal Clinical Psychologist) and Jennifer Edgeworth with Fergal Fox HSE Health Promotion Manager launching the Stress Control Classes as part of the FREE Community Based Health Promotion Progammes for Longford.

providing this platform to promote positive mental health. This is crucial for us to reach out to the community.”

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Dublin mid-leinster // News

Garden Project to Boost Local Community

'Conversations on a Homecoming' staged for Arts and Health Partnership

More than 300 people travelled to Athlone to transform a dilapidated wasteland into a beautiful and tranquil space to be used by the wider community. It is planned that the new space will be used by members of the Irish Wheelchair Association (IWA), Health Service Executive, the local community and other voluntary organisations based in the Clonbrusk Resource Centre, Coosan Road, Athlone, County Westmeath.

One of the most popular programmes offered by the IWA from the Clonbrusk centre is a weekly horticulture and gardening class facilitated by the VEC. As part of the future plans for the service, Resource and + Pictured at the official opening of the Clonbrusk Outreach Services Co-ordinator Monica Resource and Outreach Centre, L-R: Hugh Farrell, Hughes proposed to develop a fully Irish Wheelchair Association; John Tynan, Regional accessible and sensory community garden Manager, IWA Athlone; Denis O’Reilly, Difference Days; Anne Naughton, Clonbrusk Resource and Outreach which members of the association and the Centre Manager; Travis Carpico, President, Fidelity local community could enjoy and maintain.

Investments Ireland; and Joe Whelan, HSE Community In just one day, the staff of Fidelity Services Manager. Front Row: Pauline Ward and Investments Ireland created an accessible Shauna Wallace, who receive services from the exercise path, raised wheelchair-accessible Clonbrusk Resource Centre in Athlone. vegetable plots and flower beds, seating areas, bird and window boxes and a play area which can be used by IWA and the other organisations based in the centre.

These organisations include The National Council of the Blind Ireland, Multiple Sclerosis of Ireland, the HSE and a childcare facility. Maura Morgan, HSE General Manager said: "Our clients will benefit from this welcomed initiative which will bring hours of pleasure in the outdoors to the local community, including people with disabilities in Athlone. The provision of the creative colourful murals on the walls in the resource centre will bring lots of vitality and entertainment for children with disabilities and others."

Thanks to the generosity and support of Fidelity Investments Ireland, IWA successfully completed the community garden project over one day. It is planned that the community and sensory garden will also be utilised by the physiotherapists, occupational therapists and other healthcare professionals based in the centre, enhancing the standards of excellence in care for people with disabilities living in Athlone.

Described as “one of the mightiest plays” by theatre critics, DruidMurphy presented Conversations on a Homecoming, directed

by Garry Hynes in the Pavillion Theatre, Dun Laoghaire during the summer. The performance was part of the Arts and Health Partnership of Dún Laoghaire/Rathdown County Council arts office and social inclusion unit (DLR) and the HSE Health Promotion Service, DML. The Arts and Health Partnership aims to make creativity intrinsic to life within residential and day care and for those with disabilities.

The performance was assisted by audio describe, captioned and with Irish Sign Language (ISL) captioning.

The play is set in 1970s County Galway and even the humble small town pub can be a magnet for dreamers. In the 1960s, the White House pub was the magnet that provided a draw for people – for the more open minded, hopeful and radical young people of the town.

Now in his 30s and over a long drinking session on a winter’s evening, Michael – recently returned from New York after a ten year absence – has a reunion with old friends in the White House. He was the one member among them who got away to live the dream, and now he is back.

“The Arts and Health Partnership reflects our belief that participation in the arts enriches quality of life and has a positive influence on the general well-being of all involved, says Máire Davey, Assistant Arts Officer – Participation and Learning, DLR Arts Office.

“Assisted performances are important as they give full access to audience members with sensory impairments."

Midland Schools Taking the Healthy Approach Post-primary schools across Laois, Offaly, Longford and Westmeath have been invited to become a health promoting school since the start of this year. The initiative has been developed by the HSE with input from the Department of Education and Skills with the aim of strengthening the schools' capacity as a healthy setting for living, learning and working.

It forms part of Well-Being in PostPrimary Schools: Guidelines for Mental Health Promotion and Suicide Prevention. A

dedicated schools health promotion officer is employed by Athlone Education Centre with support of a health promotion officer from the HSE. Fergal Fox, HSE Health Promotion Manager said: “We are really encouraged by the reaction to this programme and see it as fundamental to us reaching young people, their parents, teachers and mentors with valuable health and wellbeing practices which can make a positive difference.”

The aims of a HPS are to foster the healthy development of the whole-school community, and to provide a framework for developing health promotion initiatives in a way that supports and enhances the implementation of the curriculum. It also supports the planning, implementation and evaluation of healthrelated activities under school self-evaluation and school development planning processes, and enhances the links between schools and their communities.

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News // Dublin mid-leinster

Work4You Neuro-assessment Launched The first community based neuro-assessment service of its kind in Ireland was recently launched in Mullingar.

Launched by specialists of Acquired Brain Injury Ireland, the Work4You service will provide practical assistance to people with acquired brain injuries (ABI). The service deals with people who are either struggling to hold onto their existing job, or aiming to return to education, training or employment.

A senior occupational therapist will assess the participants using the internationally-recognised VALPAR vocational assessment tools.

Work4You considers a holistic assessment of the individual, outlining the supports they need to achieve their set goals. The assessment takes into account the individual's functional and work capacity to identify transferable skills beneficial for the potential workplace.

Mary Heffernan, Regional Manager said: “Brain injury ranges from mild to modern and traumatic. Returning to work after a brain injury is a goal set by many brain injury survivors every day.” Work4You participants and their families will be at the heart of this new service, working to identify their own capacities and areas of vocational challenge in order to build on their vocational strengths.

Economically, Work4You strives to assist in generating

Training Helps Communication in Dublin South West Healthcare professionals from HSE Dublin South West, Tallaght Hospital and the National Rehabilitation Hospital recently attended communication training in Tallaght Library.

The free training was offered by Niamh Barrett and Aine Lawlor, + Niamh Barrett (left) and Aine Lawlor (right), speech and language speech and language therapists, HSE, Dublin therapists in Dublin South West.

South West, to anyone who interacts with members of the public and wanted to improve communication accessibility in their setting.

The workshop aimed to give tools to improve communication skills and raise awareness of communication access in services for people with communication difficulties including aphasia post stroke, literacy difficulties, intellectual disability or where English is not the first language.

The training is adapted from the Making Communication Accessible training offered by Connect, a registered UK charity. It was aimed at "making communication access a reality and making interactions, documents and environments more accessible," Niamh said.

The training focuses on practical strategies to improve communication to enhance access for people with communication difficulties. For more information please contact Niamh Barrett, Senior Speech and Language Therapist at niamh.barrett@hse.ie.

+ Pictured taking part in Work4You are, L-R: Doreen Tobin, Local Service Manager, Teach Fáilte, ABI Ireland; Mary Heffernan, Regional Manager, ABI Ireland; Sinead Thornton, Case Manager, Teach Fáilte, ABI Ireland; Elaine Butler, Work4You Senior Occupational Therapist; Vanessa McGuiness, Work4You Facilitator; Louise Ward, Work4You Facilitator.

employment throughout Ireland. ABI Ireland has recently hired three occupational therapists and six vocational facilitators to run this programme for the next two years in the BMW region.

Approximately 13,000 people acquire a brain injury in Ireland each year and face a dramatically altered life thereafter.

EVE Estuary Artists' Group Featured at Body and Soul Participants from EVE Estuary collaborated with onsite artist Rachel Kiernan to create their work entitled A Trip to the Moon, an interactive sculptural + EVE Estuary artists' work featured at the Body replica of a ‘paper moon’ and Soul festival in County Westmeath. photographic prop.

The artists were inspired by images of couples, friends, family and children posing on the moon. Many of the people were obviously having a good time – smiling and messing about for the camera.

The installation created a similar scene at Body and Soul, where people interacted in a world of fantasy and romance, and re-lived childhood dreams and memories in a creative and individualistic way.

The ethos of the Body and Soul festival, and the alternative art forms that were exhibited there over the years, have provided a space for people to imagine, see and experience the world through different forms, an ethos which EVE Estuary participants embraced wholeheartedly under the guidance of artist Rachel Kiernan.

“The opportunity to exhibit at Body and Soul was a fantastic experience – personally, artistically, socially and educationally for everyone involved,” she said. “The fun, romance, mysterious and playful element of this piece, as well as its invitation for people to engage with it, awakened people's creative energies.”

Modern cameras, telephones and apps provided the means for people to create their own individual pictures at the installation during the Body and Soul festival. You can read the EVE Estuary blog at www.eveestuary.com.

Health Matters 67

Dublin mid-leinster // Gallery

+ Evelyn Garvey, Chief Pharmacist Oncology Haematology, Aseptic Services, MRHT, congratulates Trish Scully, Senior Pharmaceutical Technician, on winning both the Hospital Pharmacists' National Technician poster competition 2013 and the National Association of Hospital Pharmaceutical Technicians poster competition 2013.

+ Tadhg Reddan, winner of the Jacques Servier Award at the Hospital Pharmacists' Association of Ireland annual conference in April.

+ Pictured at the Renal Dialysis Art Exhibition at the Midland Regional Hospital at Tullamore are Sean Bowe, Enrica Cullen and Mai Cowen.

+ Pictured at the annual general meeting of Dublin Mid Leinster Regional Forum held at the Area Office, Arden Road in Tullamore on July 2nd: Mr David Walsh, Regional Director for Performance and Integration, HSE Dublin Mid Leinster; Cllr Michael Dollard, Westmeath County Council, who was elected as chairperson of forum; Cllr Tommy Mc Keigue, Offaly County Council, who was elected as vice chairperson of fourm; Prof Donal O'Shea, St Columcille’s and St Vincent’s University Hospitals, National Children's Research Centre and University College Dublin, who gave a presentation on obesity: the imperative for prevention in childhood.

+ Pictured at the launch of the Healthy Schools Programme at Our Lady's Bower School in Athlone were Student Patricia Carillas, Mary McGrath, School Health Promotion Officer; Noel Casey, Principal, Our Lady’s Bower; Grainne Powell, HSE Health Promotion Officer and Student Ava McKee.

+ Michaela Keenaghan (Banager, Offaly) and Shauna Hughes (Upper Creggan, Armagh) with Michaela Morkan, Offaly Camogie Player and 2008 All Star; Oltan the Owl and Clodagh Armitage, HSE Health Promotion Officer who opened the U/14 camogie semi final at the HSE Community Games in AIT on Friday August 16th.

68 Health Matters

NEWS // SOUTH President visits St Columba’s Hospital, Kilkenny

+ President Michael D Higgins, accompanied by his wife Sabina, are greeted by Anna Marie Lanigan, HSE Area Manager Carlow/Kilkenny/South Tipperary; Mary Hickey, Activities Co-ordinator; Georgina Bassett, Director of Nursing and other staff members during his recent visit to St Columba’s.

President Michael D Higgins recently visited St Columba’s, accompanied by his wife Sabina, to officially open the new activities room, which will give space for the residents to further develop the activities they currently enjoy.

The activities room is used for meaningful activities such as art therapy, drama, tea dances, choirs, Irish dancing displays, cookery demonstrations, flower arranging, a reading room, bingo, card playing, crafts and cinema. The Friends of St Columba’s contributed significantly to the furnishings, activity materials and complementary programmes such as art therapy and drama.

Upon arrival, President Higgins and Sabina were greeted by staff including Anna Marie Lanigan, HSE Area Manager, Carlow/Kilkenny/South Tipperary and Georgina Bassett, Director of Nursing.

A tea party in the president’s honour was already under way in the activities room but before making his way there the residents' art gallery was proudly shown to the president by Mary Hickey, Activities Co-ordinator.

While mingling at the tea party, President Higgins met a very special guest: St. Columba’s resident Mary Bambrick, born in 1913 and still going strong a century later. Speaking at the official opening, President Higgins, said: “The overall patient experience is central to the delivery of services at St Columba’s.

Both management and staff alike pride themselves on the value placed on the opinion and welfare of residents.”

Cork University Maternity Hospital Designated Training Leader Cork University Maternity Hospital (CUMH) has been designated one of Europe’s leading training centres for urogynaecology and pelvic reconstructive surgery. The hospital is now the only centre in Ireland with an accredited subspecialty training programme in urogynaecology and pelvic reconstructive surgery, and is one of only seven other centres in Europe with this prestigious accreditation.

Urogynecology involves the diagnosis and treatment of urinary incontinence and female pelvic floor disorders. Countless women are bothered by a loss of bladder control, bowel symptoms and pelvic discomfort. Pelvic floor conditions are more common than hypertension, depression or diabetes.

Programme Director, Dr Barry O'Reilly, Consultant Obstetrician/Gynaecologist at CUMH said: “This accreditation is an enormous honour for CUMH and is due in no small part to the dedicated hard work of all the staff, particularly Dr Suzanne O’Sullivan, Consultant

+ Pictured at the announcement of CUMH as an accredited training centre for urogynaecology and pelvic reconstructive surgery were back row (L-R): Professor Linda Cardozo, President, European Urogynaecology Association (EUGA) and EUGA assessors Professor Ekhard Petri and Professor Bernard Jacquetion. Front row: Drs Suzanne O’Sullivan and Barry O’Reilly, Consultant Obstetricians/ Gynaecologists, Cork University Maternity Hospital.

Obstetrician/Gynaecologist; the nursing staff, Mr Emmett Andrews, colorectal surgeon and Mr Ciaran Brady, urologist. The work that we do here is truly multidisciplinary, involving continence nurse specialists, pelvic floor physiotherapists, as well as colorectal and urological surgeons.

Urgent Care Centre Opens at Bantry General Hospital The secured future of the hospital and an enhanced range of services was the consensus reached by many associated with the recent opening of the Urgent Care Centre at Bantry General Hospital, despite initial concerns from those advocating on the hospital’s behalf.

The Urgent Care Centre is made up of a local injury unit and a medical assessment unit, with patients attending the unit that best suits their healthcare needs.

90 per cent of patient treatment remained unchanged at the hospital. Patients with medical emergencies such as suspected heart attacks or strokes are continuing to attend 24 hours a day, seven days a week either through a GP, SouthDoc or self-referral.

Two doctors with a wide experience in emergency and minor injury medicine, Dr Rachel Fellowes and Dr Jeff Featherstone, have been recruited to work in the local injury unit. Dr Fellowes has joined the hospital staff having worked for the last year in Cork’s first local injury unit at the Mercy Urgent Care Centre in Gurranabraher, Cork city. The experience gained there will prove invaluable

+ Dr Rachel Fellowes begins work at the new Urgent Care Centre at Bantry General Hospital.

for Bantry patients as the Mercy Centre has gained a first-rate reputation in skilfully treating patients with minor injuries within an hour. Dr Jeff Featherstone was one of the first GPs in the UK to be able to perform endoscopies and sophisticated minor surgery in a GP surgery, rather than in the traditional hospital setting.

Patients referred to the medical assessment unit are being seen by a senior doctor within an hour of arrival with ready access to diagnostics such as x-rays, blood tests, scans, etc. This facilitates early diagnosis and initiation of appropriate treatment, which results in patients being discharged earlier, reduces the volume of medical admissions and shortens the length of time patients spend in hospital.

Health Matters 69

SOUTH // NEWS

Kerry Suicide Response Plan Launch A new plan to address the issue of suicide in Kerry was recently launched by Minister Kathleen Lynch TD, Minister of State, Department of Health. The plan aims to raise awareness of the supports available to people in distress or crisis and who may have thoughts of suicide. Information materials have been developed advising people of the available supports.

The plan also offers co-ordinated support and practical help to people and families affected by suicide. A local response team is available in large towns (also covering surrounding areas) to provide a timely response in the event of a suicide. The team includes HSE staff (e.g. mental health nursing, child care, community workers and primary care staff) and local community stakeholders (e.g. clergy, gardaí, GPs). This

response team will link with the appropriate voluntary organisations to put in place necessary supports.

The Kerry Suicide Response Plan was developed by the Kerry Suicide Response Forum, a HSE-led interagency partnership of 29 statutory, community and voluntary groups.

Michael Fitzgerald, Area Manager, HSE Kerry and Chairperson of the Kerry Suicide Response Forum said: “This plan and the Forum will continue to raise awareness of the services and supports available on a 24-hour basis. International and national evidence tells us that by integrating services and working together we can reduce rates of suicide and improve the wellbeing of the population in Kerry.”

Dr Margaret Kelleher, consultant

Dunmanway Community Hospital recognised for its Performance Management Staff at Dunmanway Community Hospital made the 2013 Biomnis Health Care Innovation Awards finals for their introduction of a HSE performance management pilot study. The hospital was successful in the innovation in quality of service delivery category.

The pilot study was established and agreed with the staff following + Catherine White, Director the publication of the HSE guidance of Nursing, Dunmanway document on performance management Community Hospital; Frances (March, 2012). The purpose of the study Fitzgerald TD, Minster for Children and Youth Affairs was to use the HSE guidance document and Theresa Healy-Kingston, to identify personal and professional CNM2, Dunmanway developments required to improve the Community Hospital. hospital’s performance and outcomes in an older person residential care facility.

Education and training was organised for all participating staff. The project commenced in April 2012 and was evaluated by an external facilitator in May 2013. Following the evaluation process, the outcomes were analysed using quantitative and qualitative data collection and a report of the outcomes will be published shortly.

The hospital’s director of nursing, Catherine White, says: “it’s a great honour to have this project recognised for the valuable contribution it has already made to our organisation; the participating staff who supported this development and are now leading the way in what promises to be a very valuable resource for all health care facilities. To date the project has fostered an ethos of equilibrium and the delivery of common agreed organisational goals. Staff feel ‘valued’ and their opinions ‘listened to’.”

+ At the launch of the Kerry Suicide Response Plan (L-R): Ciaran Austin, Director of Services, Console; Minister Kathleen Lynch TD, Minister of State, Department of Health; Michael Fitzgerald, HSE Area Manager for Kerry.

psychiatrist with the HSE in Kerry said: “I have no doubt but the Kerry Suicide Response Plan launched here will help assist people in distress who may have thoughts of suicide and the families and communities who have been affected by suicide”.

North Cork Improving Dementia Support Services Two new support services for the increasinglyprominent issue of dementia are now available in Mallow.

Creating clarity and connections + Amy Murphy, Service Manager, Alzheimer Society of supports people Ireland; Dr Cormac Sheehan, Research Officer, Mallow with dementia and Primary Healthcare Centre; Yvonne Finn Orde, HSE their families. A key South General Manager; Sheena Cadoo, Occupational Therapist, HSE South and Dr Audrey Russell, GP, objective is also to support staff working Mallow Primary Healthcare Centre and Clinical Academic Research Fellow, UCC at the opening of a with people with memory resource room. dementia and assist them in raising awareness of the condition, promoting early diagnosis and reducing associated stigma.

A memory resource room in Mallow Primary Healthcare Centre also recently opened. The room is an informal space and has a weekly drop-in facility where family, carers or people concerned about their memory can speak to a healthcare professional for advice, support and information. The service is available to anyone concerned about their memory or anyone with a diagnosis of dementia.

The Crystal Project is a HSE-funded project led by the HSE South Occupational Therapy Service and involves collaboration between other HSE departments, the Alzheimer Society of Ireland, family carers, UCC and GPs in Mallow’s Primary Healthcare Centre.

The occupational therapy department, in consultation with all its stakeholders, has been developing specialised dementia initiatives in the north Cork region over the last two years.

70 Health Matters

NEWS // SOUTH

Cumasú – The Wellness Bus Hits West Cork

+ Gretta Crowley, Operations Manager, Integrated Service Area – Cork; Ms Kathleen Lynch TD, Minister of State at the Department of Health with Responsibility for Mental Health; and Dr Pat Bracken, Clinical Director and Consultant Psychiatrist, Cork Mental Health Services.

A new mobile service for people recovering from mental health issues has taken to the roads of west Cork. The first project of its kind in the country, Cumasú –or the

Wellness Bus was launched by Kathleen Lynch TD. Cumasú, which means to empower or to redeem, is a community project that is

Fast Access Physiotherapy Clinic Proves A Winner In The ED A pilot clinical specialist physiotherapist (CSP) post established at the Mercy University Hospital, providing fast access to a physiotherapist for patients in the emergency department, promoted a one-stop-shop ethos of care, improving patient journey and reducing the need for return visits, a report has found.

The CSP competently managed first contact musculoskeletal presentations, freeing up the registrars for more medical-specific tasks. The CSP was an invaluable educational resource regarding all aspects of musculoskeletal assessment and management.

The project was run initially in the emergency department at the Mercy University Hospital (phase one), and later at the new Mercy Urgent Care Centre (phase two). During phase one at the ED, 295 patients were seen. Some 409 patients had their first contact with the CSP at the Mercy Urgent Care Centre in the second phase. On average, the CSP saw 41 per cent of all new patients and 35 per cent of all attendances per day. Patients seen by the CSP did not need to be seen by the on-site doctor.

Patient and staff surveys reported very high levels of satisfaction.

“Given the success of this pilot, the CSP’s first contact role should be taken into consideration when finalising the staffing complement for local injury units or urgent care centres,” explained report authors Carol Forbes, Clinical Specialist Physiotherapist; Spencer Turvey, Physiotherapy Manager, MUH and Sinead Glennon, Reorganisation of Acute Services, HSE Cork and Kerry.

being undertaken by the HSE South’s West Cork Mental Health Services in partnership with the National Learning Network, RehabCare, West Cork Development Partnership and service user groups. The project is funded by the Genio Trust, which supports innovative projects that positively impact on the lives of people in Ireland who are marginalised in society. The Wellness Bus which, in partnership with local community groups, will provide physical, mental and social well-being services for the whole community through initiatives rooted in recovery and social inclusion.

Speaking at the launch Michael Bambrick, Director of Nursing with the HSE South’s West Cork Mental Health Services, said: “The Wellness Bus wishes to promote social inclusion by bringing people together in utilising the bus as a space for creative and novel initiatives.”

Monthly Live Music Performances at Waterford Regional Hospital A three-day music residency entitled Music in Hospitals – Seven Years On took place at Waterford Regional Hospital in May, hosted by the Waterford Healing Arts Trust. The project was an opportunity for Waterford and visiting musicians to reunite seven years after the hugely successful Music + Musician Liam Merriman working with a in Hospitals project launch to patient during the recent music residency showcase and share how their at Waterford Regional Hospital. work has progressed.

They facilitated workshops with clients of Waterford Regional Hospital and St Otteran’s Hospital, and there was an event for the public to hear about how this work impacts on clients, family members and hospital staff.

Healing Sounds, which is also funded by the trust, organises live monthly music performances at Waterford Regional with musicians performing in the main foyer, wards and outpatient clinics. The approach has been influenced by the methodology of Musique et Santé, whereby musicians read the varying contexts, engage with patients and perform responsively.

Waterford Healing Arts Trust (WHAT) is an arts and health organisation based at the hospital. Its music programme spans from hospital-based performances to participatory music workshops in hospital and community settings. To read more about this and other arts and health projects, visit www.artsandhealth.ie/case-studies

Health Matters 71

SOUTH // Gallery

+ A patient information DVD on breast reconstruction is being made available to patients at Cork University Hospital (CUH). The DVD, the first of its kind in Ireland, has been developed in CUH by Mr Eoin O’Broin, plastic surgeon and his team, with the valued participation of some of his patients. It was funded by Aid Cancer Treatment (ACT). Pictured are Antoinette Cotter, Cancer Services Clinical Co-ordinator, Mr Eoin O’Broin, Consultant Plastic Surgeon and Mary Murphy, Cancer Care Manager.

+ Gavin Carey, Ruairi O’Brien and Jerry O’Connell, all based in the Maintenance Department at Mallow General Hospital, have become running enthusiasts after recently taking up the sport during their lunchtime for health and fitness purposes, recognising the importance of physical activity in everyday life. The guys competed in the Doneraile Park five kilometre run and will continue to take part in local races. The next big challenge for the novices will be to complete the Dublin City Marathon in October.

+ Tony McNamara, CEO, Cork University Hospital; Dr Diarmuid Quinlan, Chair of the HSE South Diabetes Strategy Implementation Group; and Gabrielle O’Keeffe, General Manager, HSE Cork and Chairperson of the Retinopathy Sub Group, pictured at the publication of the evaluation of a community-based retinopathy screening initiative in Cork.

+ Antoinette O'Connor, Mary Murphy, Colette Grant, Noreen Twohill, Donal Buggy, Aileen McHale. Joan Kelly and Ber Barker pictured at the launch the Irish Cancer Society’s Daffodil Centre at Cork University Hospital. The Daffodil Centre, run by Irish Cancer Society's cancer information service nurses and trained volunteers, is an information service on-site in the hospital for people affected by or concerned about cancer. The Daffodil Centre is the result of a successful partnership between the Irish Cancer Society and Cork University Hospital.

+ Pictured at the opening of the new Mallow Medical Assessment Unit were Dr Ceara Hart, general physician with a special interest in cardiology and clinical lead; and Mr Aamir Majeed, Consultant Surgeon.

+ A HSE South team recently participated in the inter-firm dragon boat challenge as part of a maritime festival in Cork. Dragon boats are 40ft long, originating in China over 2,000 years ago. Today dragon boating is popular worldwide. The HSE South 15-strong crew completed the 250m distance – with only one practice session under their belts they were knocked out in the heats but hope to return for next year’s challenge! Pictured are the 15 crew members with their supporters.

72 Health Matters

News // west New Hospital Group for the West/North West Bill Maher, CEO of the Galway and Roscommon University Hospitals Group, has welcomed the Minister’s announcement setting out the composition of the new hospital group for the West/North West.

“The new group will have autonomy to manage resources, both funding and staffing, in a way that is appropriate to the needs of the patients we treat.

“Noel Daly was appointed chair of the group by the Minister for Health last May and five non-executive directors were appointed in January this year, with a further three in June. The remit of the board is to develop effective corporate and clinical governance structures along with quality and safety systems of care for patients. Much of this work has been completed and we will now work to integrate the new hospitals into a common governance arrangement and put structures in place to bring the hospitals to the next level of performance and accountability. All of this will be done in a manner that is transparent to the people of the region with a number of board meetings

+ At the first public meeting of the board held on June 18th in University Hospital Galway, from left: Dr Brendan Day, Non-Executive Director; Fiona McHugh, Head of Corporate Development, Galway and Roscommon University Hospitals Group; Bill Maher, Group CEO; Noel Daly, Chair of the Board; Colette Cowan, Group Director of Nursing and Midwifery; Dr Pat Nash, Group Clinical Director; and Phyllis MacNamara, Non-Executive Director.

being held in public, the first of which took place in June in Galway.

“The Galway and Roscommon University Hospitals Group was one of the first two groups set up in January 2012. The progress the group made in the first year and a half in terms of improvements in the services

Memorial Garden Officially Opened at St Brendan’s Community Nursing Unit The refurbished memorial garden at St Brendan’s Community Nursing Unit in Loughrea, Co Galway was officially opened by 103 year-old Johanna Connaughton in June.

Before the official opening, residents along with staff and people from the local community gathered in the garden to celebrate + Johanna Connaughton cutting the tape with Bernie Austin and Nora Callaghy, mass with Rev Bishop St Brendan's Community Nursing Unit; Cllr James Regan, Mayor of Loughrea; John Kirby and Rev and Bishop John Kirby and Monsignor Cathal Geraghty who concelebrated mass at the official opening of Garrai na mBocht memorial garden to remember the Monsignor Cathal many people from Loughrea and its hinterlands who were buried there during the Geraghty. Following the bleak famine years. ceremony and the official opening, children from Scoil Riabhach, Loughrea performed a sketch of life in famine times.

Bernie Austin, Director of Nursing, St Brendan’s Community Nursing Unit, said: “The memorial garden is a tranquil spot where people can come to spend time and reflect. It has been a fantastic challenge for everyone concerned. The project was the brainchild of Clinical Nurse Manager Nora Callaghy, whose vision and determination to bring the garden to this level cannot be underestimated. I am delighted with the finished product and confident that the garden will provide lots of enjoyment for our residents and visitors alike.”

provided to patients – reduced ED waiting times, meeting the inpatient waiting list targets, developing services at Roscommon Hospital – demonstrates the success of establishing hospital groups/trusts as part of a programme of reform of the Irish health system.”

National Newborn Hearing Screening Programme Goes Live In The North West HSE West commenced a phased introduction of the National Newborn Hearing Screening Programme at the beginning of May. The first hospitals to go live in the West were Letterkenny General Hospital and Sligo Regional Hospital. The new service provides a routine hearing screening test to newborns. The test is a quick and simple way to check a newborn baby’s hearing.

The screening test is usually done before the baby leaves the hospital. A trained hearing screener carries out the test. The screener places a small softtipped earpiece in the outer part of the baby's ear which sends clicking sounds down the ear. When an ear receives sound, the inner part, known as the cochlea, usually produces an echo. The screening equipment can pick up this echo. The screening test only takes a few minutes and does not hurt the baby.

Health Matters 73

west // News Minister of State Kathleen Lynch TD Visits Jigsaw Donegal

Pauline Kent, Smoking Cessation Coordinator, Sligo Regional Hospital; Louise O Kennedy, champion for campaign; Dr Amjad Zaman Khan, Consultant Geriatrician, SRH; Micheal McGloin, champion for campaign; Dr John O’Doherty, Consultant Geriatrician, SRH.

+ From left: Karen Duggan, Administration Officer; Christina Greene, Clinical Support Worker; Gary Cassidy, Youth Enagement Officer; Sean McGrory, Project Manager; Minister Kathleen Lynch TD; Jennifer McClean, Clinical Support Worker; Rachel McGlinchey, Youth Advisory Panel and Wendy Tourish, Receptionist.

Minister of State for Disability, Equality, Mental Health and Older People Kathleen Lynch TD visited Jigsaw Donegal in May. The service provides a safe and confidential space where young people can access mental health supports for free. Located at Pearse Road, Letterkenny, it works with people aged from 15 to 25 and its main aim is to enable access to the most appropriate services in as seamless a way as possible, whatever the level of need.

The Jigsaw programme was designed by Headstrong and its panel of youth advisors and is an evidence-based integrated service, designed to strengthen a community’s capacity to support young people’s mental health. It works on a partnership model of pulling together and aligning all existing resources and expertise in any given community.

Minister Lynch met with HSE and Jigsaw staff and 17 year-old Rachel McGlinchey of the Jigsaw Donegal Youth Advisory Panel briefed the Minister on how young people guided the process of bringing Jigsaw to Donegal from its inception to opening in October 2012.

Sod Turning Of The Ballinamore Primary Care Centre And Care Managed Unit Mr Frank Feighan TD performed the official sod turning for the new Ballinamore Primary Care Centre and Care Managed Unit at the Line Road, Ballinamore, Co Leitrim in July. This development will involve the building of + South Leitrim Primary Care Team, Community Health Forum and HSE staff. a modern purposebuilt primary care centre and interconnected 20-bed care managed unit which will also include a day service facility. The commissioning of the building is planned for September 2014, and the total cost is s5.9 million. Architects for the project are Reddy Architects.

The primary care centre (PCC) will provide accommodation for members of the South Leitrim Primary Care Team including GPs, public health nurses, occupational therapy, physiotherapy, chiropody and dental healthcare facilities. Multi-disciplinary bookable clinic rooms for visiting professionals including dieticians, speech and language therapists, psychologists and community mental health services will also be available in the centre.

Smoke Free Campus At Sligo Regional Hospital A Success Story On May 31st Sligo Regional Hospital introduced the smoke free campus policy, which means that it is no longer possible to smoke anywhere on the hospital grounds – for example, entrances, doorways, walkways, internal roads, car parks, bicycle shelters, etc.

The policy applies to all staff, patients, visitors, contractors and anyone who enters the campus grounds. SRH is in line with the HSE target of introducing the smoke free campus policy to all HSE sites by 2015.

Since its introduction, the initiative has been widely welcomed by the majority of people, both smokers and non-smokers. It is particularly welcomed by patients who have to visit the hospital on a frequent basis.

Grainne McCann, General Manager at SRH says: “The introduction of the smoke free campus has provided positive change for the hospital. It has assured the creation of a healthier tobacco-free environment for our service users/patients, staff and visitors.”

According to Pauline Kent, Smoking Cessation Coordinator at SRH, “The hospital has been really appreciative of how the staff, members of the public and patients have accepted this major cultural change of no longer being able to smoke on the hospital site. The majority are totally respectful and understand why we have a responsibility to support this HSE initiative. We have also noticed an increase in the percentage of both staff and the public who wish to quit smoking as a result of the ban, so that has been another positive development.”

74 Health Matters

News // west Galway University Hospitals Launches Antibiotic Use App

Taoiseach Unveils Plaque On Sacred Heart Hospital Site

+ Taoiseach Enda Kenny along with HSE staff at the unveiling of the memorial plaque at the Sacred Heart Hospital in Castlebar. +At the launch of the Galway University Hospitals mobile app for antimicrobial prescribing guidelines, from left: Connie Merrick, Hospital Speciality Representative, MSD; Dr Eithne McCarthy, Consultant Microbiologist, GUH; Dr Deirbhile Keady, Consultant Microbiologist, GUH; Marie Tierney, Antimicrobial Pharmacist, GUH; Mick Phelan, Business Unit Director, MSD; and Dr Pat Nash, Group Clinical Director, Galway and Roscommon University Hospitals Group.

Galway University Hospitals launched a new app for antimicrobial prescribing guidelines in July. Dr Pat Nash, Clinical Director for the Hospital Group, said: “The development of the mobile app is the latest innovation to further improve appropriate antibiotic use by giving our doctors and nurse prescribers easy access to the guidelines at the point of prescribing.”

According to Professor Martin Cormican, Consultant Microbiologist and member of the antimicrobial stewardship team at the hospital, "Antibiotics have often been misused; antibiotics are often used when they are not needed and sometimes when antibiotics are needed the antibiotic used may not be best antibiotic for that situation. We have to take steps to improve the use of antibiotics, otherwise we risk squandering one of the most important medical advances of the past 100 years.

"The new mobile app means that staff have information at their fingertips on the best antibiotic to use for each infection; it is extremely easy to use and it also means that we can update the information very quickly.”

The app was kindly supported by an educational grant from healthcare company MSD.

Sligo Project Wins Prestigious Award + L-R: Anne Ward, Carla O’Hara, Rodrigo Frade with his award, Theresa Peacock and Ruth Boland.

Rodrigo Frade, Senior Occupational Therapist at HSE Sligo Mental Health Services has accepted the Ann Beckett award for his work on the men's shed initiative in Sligo at the Association of Occupational Therapists of Ireland (AOTI) annual conference. The award is given to the project that has shown how to best promote

inclusion and links with community agencies, amongst others, during the previous year.

It is an enriching process for occupational therapists and an opportunity to demonstrate the core principles of occupational therapy practice. The committee looks for practical projects and creative interventions which empower clients.

The men's shed initiative in Sligo started with a partnership among the senior occupational therapists for Sligo Mental Health Services: Rodrigo Frade, the Men's Health Development Officer for the Sligo Leader Partnership, Jonathan May, and a group of men from Sligo. A men’s shed may have many different aims, and from Rodrigo’s perspective the goal was to create a space that promoted good mental

Taoiseach Enda Kenny TD recently unveiled a memorial plaque on the site of the Sacred Heart Hospital in Castlebar in memory of the people who lived and now rest on the site of the hospital. The dedicated plaque has been erected in honour of those who were laid to rest on the site from the time of the Famine up to as recently as the 1950s.

According to Padraic Carolan, Senior Administration Officer, HSE Mayo and chair of the organising committee, “we thought it would be appropriate and a sign of respect to erect a memorial plaque on the site of the Sacred Heart Hospital where people could come and remember and acknowledge those people who have lived and are now buried here. It is a place where people can come to pay their respects and remember those who have gone before.”

The wording is from a poem by Derek Mahon entitled 'Kinsale', was selected to symbolise going from darkness into light.

The hospital operated as a workhouse from 1842 until 1921; from 1921 to 1973 the building was known as the County Home.

In 1973 the current building was opened as the Sacred Heart Hospital.

health and wellbeing and encouraged social inclusion.

Rodrigo is from Portugal and is currently finishing an MSC in University College Cork. He has worked for the HSE for over four years. Rodrigo explained what the award means to him: "It is recognition of the quality of the work developed by occupational therapists and the HSE for their service users and for the wider community in Sligo.”

Health Matters 75

west // Gallery

+ Enjoying the lunchtime Fourth of July celebrations at University Hospital Galway were Mary McLoughlin, Clinical Facilitator Cancer Services, UHG; Jason Smith, Chef, Aramark, UHG and Margaret Monaghan, Restaurant Manager, Aramark, UHG.

+ Bregeen Cassidy (left) and Ann O’Toole are two of the Meet and Greet Volunteers at University Hospital Galway. They signed up to be volunteers as they believed it would be a useful way of giving something back to the community, and they have discovered over the past few years what a valuable and appreciated service it is to people visiting the hospital.

+ To celebrate Bealtaine, residents at the Plunkett Community Nursing Unit in Boyle undertook several activities including the establishment of a knitting club, which was facilitated by Iris Field to make blankets for the African missions. Wool for this project was donated by the local community in Boyle. From left: Margaret O Connor, Eithne Cahill, Iris Field, Mary Gardner, Chrissie Corrigan, Violet Jordan and Bridie Keaveny.

+ At the launch of This Never Happened II, a collection of poetry and stories by patients, staff and visitors to Galway University Hospitals, from left: Kevin Higgins, Writer in Residence, GUH; Madeline Moloney, Unit Five resident and contributor to the book; Fiona Falvey, GUH staff and contributor to the book; and Dr Oscar De Souza, Tirellan, former resident and contributor to the book.

+ Pictured at the presentation of a cheque for e2,100 at Aras Mhuire Community Nursing Unit in Tuam (back row, left to right): Nora Costello, Healthcare Assistant; Gretta Lee, Staff Nurse; Frances Ryan, Staff Nurse; Julie Silke-Daly, Director of Nursing and Caroline Coen, Person in Charge. Middle row, left to right: Nora Quirke, Paddy Rainey, Vera Fallon, Roger Hughes and Elisabeth Connell, all residents at Aras Mhuire. Front row: Anthony Simo-Leifi and Andrew Furey, fundraisers.

+ Residents of St Catherine’s Ward, Sacred Heart Hospital, Roscommon were delighted to win a bird feeder after being entered into a competition in the Bloom Festival in the Phoenix Park, Dublin. L-R: John McWatt; Bridie Stephens, CNM2; Eric Cavanagh; Christina Waldron; Rose McDonald; Larry Barrett and Julie Silke-Daly, Director of Nursing, Sacred Heart Hospital.

Health Matters 77

Commercial Feature

Bone Health

Important Through Every Stage of Life The skeleton has a number of essential roles such as enabling mobility, providing protection and ensuring support. Although bone mass is determined to a large extent by non-modifiable factors such as genetics, age and race; modifiable factors such as diet and lifestyle are also very important. It is, therefore, essential that we follow a ‘bone friendly’ diet and lifestyle during all stages of life.

Other nutrients, for example, vitamin D, are also important for bone health.This vitamin helps to maintain normal bones as it contributes to the normal absorption and utilisation of calcium. Vitamin D is commonly referred to as the ‘sunshine vitamin’ but dietary sources such as oily fish and eggs should be included as well, to provide us with a source of this nutrient.

In addition to a healthy diet, regular participation in weight-bearing activities such as running, dancing and most team sports is also important for bone health. Maintaining a healthy body weight, limiting alcohol intake and refraining from smoking are also advised.

Bone Development Bone mass increases until peak bone mass is reached – this is the highest level of bone mass achieved as a result of normal growth.

Adolescence is a critical time in bone development as it is thought that about half an adult’s bone mass is laid down during this short time frame. Continuing on into adulthood, one should remain mindful of bone health and the age-associated decline in bone mass. For women, the menopause is considered another critical point in terms of bone health.

Diet and lifestyle A balanced diet and healthy lifestyle supports the development and maintenance of the skeleton. Here in Ireland, the Department of Health’s Food Pyramid provides guidelines for adults and children over five years of age to assist in following a balanced diet.

As part of a balanced diet, the Food Pyramid recommends three servings from

the ‘milk, yogurt and cheese’ food group each day, increasing to five daily servings for those aged between nine and 18 years.

This increased recommendation reflects the importance of calcium during this life-stage. Examples of one serving from this food group include 200ml milk, 125ml yogurt or 25g of cheddar-type cheese.

Calcium is an essential nutrient in our diet; 99 per cent of the body’s calcium is found in our bones and teeth. This mineral contributes to the growth, development and maintenance of the skeleton. Indeed, milk, yogurt and cheese provide an important source of calcium in the Irish diet with national surveys reporting that milk and yogurt, collectively, contribute 30 per cent of the calcium intake among Irish adults and 33 per cent of the calcium intake among Irish teenagers. Worryingly, however, the National Teens’ Food Survey also found that 42 per cent of Irish girls and 23 per cent of Irish boys aged 13-17 years had insufficient calcium intakes.

Osteoporosis Osteoporosis is a disease in which bones become fragile, thus increasing the risk of fracture. According to the Irish Osteoporosis Society, 300,000 people in Ireland have this ‘silent disease’ and, one in five men and one in two women over the age of 50 will develop a fracture due to osteoporosis in their lifetime. If concerned about your bone health or osteoporosis, speak to your GP who may advise a DEXA scan. If a diagnosis of osteoporosis is confirmed, a suitable treatment plan specific to the patient’s particular needs should be developed, which should include appropriate diet and lifestyle advice.

For further information visit: www.ndc.ie

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Health Matters 81

Home Instead senior care special report Adding Healthy Years Through New Care Models

+Jeff Huber, President of Home Instead Senior Care speaking at the EU Summit on Active and Healthy Ageing.

J

eff Huber, President of Home Instead Senior Care was recently invited to be a key speaker at the EU Summit on Active and Healthy Ageing. The summit was a product of the Ageing Well Network and

Global Coalition on Ageing, in association with the Irish presidency of the Council of the EU and with active engagement from the World Health Organisation's Age Friendly Cities and Counties Programme.

This consortium of partners represented a broad range of public and private sector leadership committed to creating policies, driving innovation and implementing programmes for age-friendly growth across the EU and globally.

The summit aimed to assemble the most influential European and global leaders on this topic to pave a path for economic growth and social development through the 21st century's age-related demographic transformation. Mr Huber, speaking at the Dublin event, discussed Home Instead’s

“reimagining the care continuum with home care enhancing the future of tailored person-centred care”.

“Home Instead Senior Care sees day-in, day-out the benefit home care has when it comes to enhancing the lives of seniors,” he said. “When addressing the diversity of issues faced by older people who wish to remain active in society, home care is a key element that must be considered when responding to new models of care. We are very proud to be part of such a successful event that has resulted in the creation of an active and sustainable network that going forward can help to inform policy, promote greater innovation and drive age-friendly solutions within and across EU cities and communities.”

Home Instead Senior Care Sponsors Trinity Research b300k

H

ome Instead Senior Care are pleased to announce a new collaboration with researchers at NEIL (Neuro-Enhancement for Independent Lives) in Trinity College Institute of Neuroscience. The NEIL research team aim to enhance the independence of older adults living in the community, by investigating ways in which we may prevent or delay cognitive impairment. Home Instead Senior Care are devoted to delivering personcentred, highest-quality home care for the ageing population and are delighted to be in a position to fund the e300k research project. This novel collaboration has at its core a vision of designing and delivering support to help older adults maintain their independence in their homes for longer.

The team have launched a novel and exciting project entitled RelAte, which will deliver and evaluate a mealtime intervention over the next two years. Many older adults in Ireland live independently, but to continue to do so they require support. Older adults are particularly at risk of malnutrition, which can contribute to cognitive impairment and frailty. Another risk in late life is that of social isolation due to illness, frailty and bereavement. Data recently collected by the Irish Longitudinal Study of Ageing suggests that 7 per cent of the older national

+ Karl Schutte, Owner of Home Instead Senior Care in Ballsbridge; Dr Joanna McHugh, Postdoctoral Research Fellow, NEIL, Trinity College Institute of Neuroscience; Tony O’Donovan, Business Development Manager, Home Instead Senior Care; Yoshino Nakajima, COO, Global Operations, Home Instead Senior Care; Jim Beck, Director of Public Affairs, Home Instead Senior Care; Dr Sabina Brennan, Director of the NEIL Memory Research Unity, Trinity College Dublin; and Professor Brian Lawlor.

population are socially isolated (TILDA Report on Social Engagement of Older People, 2011).

The funding will support the two-year RelAte Project that will investigate the benefit of relationship-based nutritional mealtime intervention in socially isolated older adults.

Making the announcement, Jim Beck, Director of Public Affairs at Home Instead Senior Care said: “As the leading home care company in Ireland and the globe we are delighted to be in a position to fund Trinity College Dublin to research this project. It is our goal to ‘change the face of ageing’ and

one way we can do this is to support leading academic institutions such as Trinity College Dublin to research pertinent ageing issues.”

Commenting on the research, Professor Brian Lawlor, Conolly Norman Professor of Old Age Psychiatry at Trinity College Dublin said: “We need to provide empirical evidence, through randomised controlled trials, that there are real and sustained benefits from relational and person centred care interventions for older people. Proving that these types of interventions really work is crucial for their ongoing adaptation and sustainability.”

82 Health Matters

Home Instead senior care news & Views

Free Alzheimer's Education Workshops 'Until there is a cure': Home Instead Senior Care offers free education workshops for families and communities

S

tarting this September during World Alzheimer’s Month, Home Instead Senior Care will host 1,000 education workshops worldwide for families and communities involved with the care of a person with a dementia. Across Ireland, over 30 workshops were planned in the run up to World Alzheimer’s Awareness Day on September 21st. Understanding the need for dementia care education, Home Instead Senior Care is committed to ensuring these workshops are simply the start of an on going campaign to equip as many family carers and communities with practical

techniques to support them in their role.

Alzheimer’s disease is quickly becoming a global health crisis. According to research conducted by Alzheimer’s Disease International (ADI), the number of people living with dementia worldwide, estimated at 35.6 million in 2010, is set to nearly double every 20 years, reaching 65.7m in 2030 and 115.4m in 2050.

Last year represented a pivotal moment for the 41,700 people in Ireland living with dementia – and their 50,000 carers – when the Government announced its commitment, under the Programme for Government, to

the development of a National Dementia Strategy by 2013, and Home Instead Senior Care looks forward to its publication and supporting its recommendations.

The vast majority of people with Alzheimer’s disease are cared for in their home by family caregivers during most of their disease. Understandably, most of the research time and funding is devoted to finding a cure, but it is also important to make sure the importance of family caregivers is considered in the fight against Alzheimer’s. Hence the theme of the Home Instead Senior Care campaign: Until There is a Cure.

Research from the Home Instead Senior Care network throughout the world reveals that families have two significant challenges when caring for their loved ones who have Alzheimer’s disease or other dementias: keeping their loved one’s mind engaged and managing behaviours that can include, for example, repetition and aggression. Through the CARE programme Home Instead Senior Care will provide family and community members with techniques needed to help them best manage behaviours, encourage engagement and keep their loved ones safe.

The Alzheimer’s and other Dementias CARE: Changing Ageing Through Research and Education programme offers a new, unique approach for the care of those who are living with Alzheimer’s disease or other dementias. Workshops are researchbased by leading academics in the field of dementia care and designed to empower families and communities with knowledge and practical techniques to help enable them to positively embrace the journey they face, rather than be afraid of it. This approach focuses on the behaviours, care and dignity of the senior with Alzheimer’s rather than the condition, the physiology and treatment or cure.

Home Instead Senior Care recruited a diverse panel of ageing and dementia experts that allowed them to address Alzheimer’s from all aspects of the disease.

This programme has been reviewed and refined by experts in the field of ageing, who now endorse it. Dr Amy D’Aprix,

Health Matters 83

Home Instead senior care news & Views co-author of the CARE programme and President of Essential Conversation Inc said: “Through this education programme, I believe that Home Instead Senior Care is again demonstrating their commitment to providing the highest level of care to the whole community. Families want to ensure their loved ones with dementia are safe and stay involved in life.

“Through this programme families and communities will be able to accomplish this with confidence and skill. They will also have specific techniques for managing the challenging behaviours which often accompany dementia.

“Perhaps most important, the dignity and worth of the person with dementia will be assured through the provision of care personalised to the individual.”

Ed Murphy, CEO of Home Instead Senior Care commented: “There are over 50,000 carers in Ireland supporting loved ones with dementia. Almost always, these friends and

family members helping have no experience or training to care for someone with Alzheimer’s or other dementia. By making these education workshops free and available in our community, Home Instead Senior Care is hoping to help family caregivers learn and prepare to manage the everyday challenges of Alzheimer’s disease and other dementias, as well as to raise awareness of the challenges of being a caregiver.

“With family caregivers providing the majority of dementia care, it’s important we give them the tools they need to provide the best care for their loved ones. I would urge anyone who may be worried about how to care for a loved one with dementia or is struggling in silence to attend a workshop. Our friendly staff are fully trained and what we have found is that the sharing of experiences with other carers can be a huge support. Carers need to realise that they also need to look after themselves, and by feeling equipped with the proper

knowledge and tools to face the everyday challenges of the disease they are in a better position to do so.”

Are you caring for a loved one with Alzheimer’s or other dementia? Then until there is a cure, please join Home Instead Senior Care for a FREE education workshop in your area. For more information please call 1890 930 013 or log on to homeinstead.ie.

“With family caregivers providing the majority of dementia care, it’s important we give them the tools they need to provide the best care for their loved ones.”

new cases of dementia each year – that’s a new case every 4 seconds.

The total estimated worldwide cost of dementia was

460 BILLION in 2010.

The VAST

MAJORITY

If dementia care were a country, it would be the world’s

18 TH LARGEST

of persons with Alzheimer’s are cared for at home.

W H AT D O E S T H E F U T U R E H O L D F O R T H I S D I S E A S E ?

The high health cost of carers The World Alzheimer Report 2013 provides the most comprehensive, global view of the issues surrounding

including the levels of mortality, disability, strain on caregivers The caring for and them future tends to outlook. also decline.

An dementia, 18-month study entitled examining Declining Health for Alzheimer’s caregivers.

According to the study, the caregivers’ own in the Alzheimer’s Caregiver as Dementia • D

octor visits were nearly triple compared aggressive and debilitating nature of Alzheimer’s and dementia in particular make caregiving a labour of love. health declined steadily as their loved ones' Increases in the Care Recipient compared to non-caregivers. need for assistance increased. the health status of non-caregivers to a • The average annual cost of healthcare for Howgroup can ofthe world support families asAlzheimer’s they confront thiswas global health diverse family caregivers across caregivers equivalent to crisis? Caregivers’ use of all types of medical services increased 25 per cent over the the country.

Givenabout the challenges faced by caregivers s3,564 higher than for similar-aged non• Learn the challenges face.

18-month study.

Alzheimer’s caregivers, it’s hardly surprising caregivers.

• Raise awareness of this issue that is too often overlooked.

Caregivers whose own health was only fair that they may suffer negative health effects, what works. to poor at the beginning of the study were which•this Share research confirms.

Some of the As dementia progresses, and as the • findings were: most vulnerable to the effects of increasing significant cognitive and physical abilities of dementia dependence by the care recipient.

• Emergency room use was twice as high care recipients diminish, the health of those top dementia care experts to host roundtable discussions in three international capitals to raise awareness of this critical issue and identify ways to help support family caregivers until there is a cure.

84 Health Matters

Home Instead senior care news & Views Five Ways to Be a Healthy Alzheimer’s Caregiver Much easier said than done, of course, but taking time to take care of your own needs is absolutely essential.

C

aregiving is a labour of love, and love is about selflessness and sacrifice. Spouses give up so much for each other, parents constantly put their children’s needs before their own, and when those children become grown adults with ageing parents, they want to return the love and care they received.

If you find yourself consistently making sacrifices to care for your loved one with Alzheimer’s disease, your heart is certainly in the right place. But such devotion can also take its toll on your health and wellbeing.

According to the research from Home Instead Senior Care, caregivers of individuals with Alzheimer’s disease are more likely to report higher levels of burden and stress than other caregivers due to the cognitive and physical limitations experienced by the care recipients. And a word of caution: one study (Declining Health in the Alzheimer's Caregiver as Dementia Increases in the Care Recipient) found that as care recipients’ dementias get worse, the health of their caregivers tended to diminish significantly as well.

Consciously taking steps to care for yourself is important both for your sake and your loved one’s. Feeling physically, emotionally and mentally refreshed helps caregivers be the best they can be.

1: Say Yes to Help It might require swallowing some guilt or pride, but if you feel overwhelmed, stressed to the max and exhausted, it’s time to ask for help. Talk to your other family members and come up with a solution together.

Maybe the others can pitch in more regularly to give you a respite, or maybe you’ll decide to employ outside help. Nonmedical home care from Home Instead Senior Care specialises in finding just the right caregiver to match your loved one’s needs, interests and personality. They can provide care for just a few hours per week or as much as 24/7 care. You’ll find peace of mind when you can take a break from caregiving and attend to your own needs knowing your loved one is with a trained, garda-vetted, trusted professional caregiver.

2: Stay Informed Knowledge is power when it comes

to caring for a loved one with Alzheimer’s.

Arming yourself with information will reduce worry and stress while boosting your confidence and ability to take control of your situation.

• Learn about the stages of Alzheimer’s disease so you know what to expect and can plan ahead.

• Research the types of Alzheimer’s longterm care options and check with local agencies for resources available in your community. For example, Home Instead Senior Care’s Dementia Care at Home booklet, or attend one of their FREE dementia education workshops.

• Read up on important Alzheimer’s care topics and techniques so you feel better prepared to handle the unique behaviours and needs your loved one exhibits.

3: Find Support This could mean joining a caregiver support group in your community, taking part in an online community for Alzheimer’s caregivers, or just finding a good friend willing to listen and lend a shoulder to cry on. You need a safe space to vent your frustrations (without taking it out on your family) and a source of encouragement. Caregiving for a loved one with Alzheimer’s disease or other dementias is one of the hardest jobs out there, so it may help to hear other caregivers’ stories and take the journey together.

4: Take Care of Yourself Much easier said than done, of course, but taking time to take care of your own needs is absolutely essential.

• Avoid skipping or putting off your own doctor appointments.

• Take time to yourself everyday to do something you want to do.

• Listen to your body and give it what it needs: rest, exercise, a chance to cry, a

nice massage, healthier food, a doctor’s check-up, etc.

While you will inevitably still make some personal sacrifices, limit them to the ones you feel are most important. Keep your stress levels in check and learn what you need to do to maintain your own health and spirits.

5: Focus On the Positive Make a point each day to note the things that went well, focus on what your loved one can do rather than dwelling on the difficulties, and don’t hesitate to break out your sense of humour! Never underestimate the power of a good hearty laugh to ease tension and melt away stress. Negativity, on the other hand, will just drag you down, so strive to maintain good moods and attitudes to remain at the top of your game.

Even if it seems like caring for a loved one with Alzheimer’s demands all your time and energy, know that you’re entitled to take personal time for yourself. It’s not only allowed, it’s necessary. Start right now – choose one thing you can do to feel better today and you’ll be on your way towards a more rewarding caregiving experience.

If you are a caregiver and would like more advice on how to take care of yourself check out Home Instead Senior Care’s Running on Empty. This publication acknowledges and explains emotional and physical responses to providing care. It covers topics such as how to recognise signs of stress and offers coping mechanisms that can be taken to avert potential future problems. You can request your free copy by calling 1890 930 013 or download a copy at Homeinstead.ie.

Health Matters 85

Home Instead senior care news & Views DEMENTIA COMMUNICATION STRATEGIES: THE DOS AND DON’Ts DO

DON’T

Talk to the person in a tone of voice that conveys respect and dignity.

Talk to the person in ‘baby talk’ or as if you are talking to a child.

Keep your explanations short. Use clear and flexible language.

Use complicated words or phrases and long sentences.

Glare at or 'eyeball' the person you are talking to.

Maintain eye contact by positioning yourself at the person’s eye level.

Look directly at the person and ensure that you have their attention before you speak. Always begin by identifying yourself and explain what it is you propose to do.

Use visual cues whenever possible.

Be realistic in expectations.

Begin a task without explaining who you are or what you are about to do.

Talk to the person without eye contact, such as while rummaging in a drawer to select clothing.

Try and compete with a distracting environment.

Observe and attempt to interpret the person’s non-verbal communication.

Provoke a catastrophic reaction through unrealistic expectations or by asking the person to do more than one task at a time.

Disregard your own non verbal communication.

Disregard talk that may seem to be 'rambling'.

Paraphrase and use a calm and reassuring tone of voice.

Speak slowly and say individual words clearly. Use strategies to reduce the effects of hearing impairment.

Encourage talk about things that they are familiar with.

Shout or talk too fast.

Interrupt unless it cannot be helped.

Use touch if appropriate.

Attempt to touch or invade their personal space if they are showing signs of fear or aggression.

Home Instead Senior Care provides specialised care in Alzheimer’s and other dementias. For more information call 1890 930 013 or log on to homeinstead.ie

Home Instead celebrates Public Health Nurses in Special Awards Home Instead Senior Care see first hand the invaluable contribution public health nurses across the country make to the health and wellbeing of families and communities and have therefore decided to create a new award in their honour.

Public Health Nurse of the Year sponsored by Home Instead Senior Care

Cast your vote in the Public Health Nurse of the Year and you could win a family weekend away in the Wyatt Hotel, Co Mayo courtesy of Select Hotels of Ireland.

Vote online at www.maternityandinfant.ie/awards Closing date for entries: Friday 4th October. Finalists will attend a celebrity-studded awards ceremony in November 2013 at The Four Seasons Hotel, Dublin.

The 2013 awards will be hosted by Sybil Mulcahy and Martin King of TV3’s flagship Morning Show.

86 Health Matters

Home Instead senior care news & Views

Home Instead Top Homecare Provider In England – Report H

ome Instead Senior Care has been revealed as England’s top homecare provider in a report from healthcare information specialist Laing & Buisson.

The report, Laing & Buisson’s Care Compliance Monitor, has been expanded to include headline data from Care Quality Commission (CQC) inspection reports and presents a digested view of providers’ performance.

The resulting league table shows the percentage of branches which are fully compliant with CQC’s core standards covering care, safeguarding, staffing, management and respect for service users. Home Instead Senior Care, which achieved the number one position, scored 97.8 per cent.

Commenting on Home Instead Senior Care’s performance, CEO Ed Murphy said: “Home Instead Senior Care is totally focused on providing the highest quality of care to our clients. The work we are doing across the globe in terms of our quality processes and procedures assures the safety and wellbeing of our clients and brings peace of mind to their families.

“It is gratifying to see us recognised by a leading industry organisation in this analysis of CQC performance. From an Irish perspective we would urge that similar monitoring of standards be introduced to ensure everyone being cared for in this country is at the same level as Home Instead Senior Care.”

COMPANY NAME

% BRANCHES FULLY COMPLIANT

1. Home Instead Senior Care

97.8%

2. Mencap

93.4%

3. Carers Trust

93.3%

4. Caremark Ltd

93.3%

5. Voyage

90.3%

6. Bluebird Care

87.3%

7. Saga Homecare

85.6%

8. MiHomecare Ltd

82.9%

9. Carewatch Care Services

81.2%

10. Housing 21

72.8%

© Laing & Buisson, 2013

Helping Older People Get Online Home Instead join forces with Age Action to train older people in practical computer skills.

H

ome Instead Senior Care is delighted to announce its partnership with Age Action to provide basic IT training for older people all over Ireland. Home Instead Senior Care employees will be volunteering to help older people to take their first steps online.

In today’s digital world older people are getting left behind, with seven in 10 older people not knowing how to use a computer.

This initiative will help older people to get online by training Home Instead volunteers throughout the country to provide one-toone tuition which lets people go at their own pace and learn new skills such as accessing websites or services that are of interest to them, using email and social networking.

Many older people fear technology or don’t see the relevance of it for them. Home Instead Senior Care has found that this fear is simply the fear of the unknown. Learning new skills can be a daunting experience at any age, but

now with the support of Home Instead Senior Care and Age Action older people will learn and experience the huge potential that new technology has to offer.

Ed Murphy, CEO of Home Instead Senior Care said: “We + Volunteer Ciara shows Jane how to shop online! would encourage older people to come along to classes at their local Senior Care’s mission to ‘enhance the lives Home Instead office. Being able to use a of older people, enabling them to live happy, computer can really open up a whole new healthy and independent lives at home for world for people. You are never too old to longer than otherwise possible’. learn new skills so give it a go.”

Classes will take place across the country In short, gaining computer skills has helped at local Home Instead Senior Care offices. participants significantly improve their quality For more information please call (01) 475 of life, which perfectly supports Home Instead 6989 or email gettingstarted@ageaction.ie.

88 Health Matters

HSE Community Games

Awards To Reward Outstanding Community Games Healthy Events Awards aim to encourage HSE Community Games volunteers to think about the way events are run and to try to make them more health promoting, writes Arlene Crean.

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his year's winners will be announced at the HSE Community Games Area and Healthy Events Awards in the City Hotel, Derry on November 23rd. The awards aim to encourage those involved with the HSE Community Games areas to think about the way events are organised and to try to make them more health-promoting in the areas of sun safety, physical activity, nutrition, substance misuse and mental health.

All registered HSE Community Games areas were eligible to enter for the awards, and to be eligible an area had to make their events more health promoting during the 2013 season. Some 52 areas around the county have applied for the awards, which is a great number for the first year of the event.

Ardragh/Moydow/Glen group, Longford Health Matters caught up with the Ardragh/ Moydow/Glen group in Longford, who launched their quest to capture an award for being a health promoting area by hosting a range of activities and speakers with the help of HSE Health Promotion throughout the year.

They have a weekly youth club every Friday evening, and here they provided fun activities focused on promoting and encouraging healthy choices in the areas of physical activity, healthy eating, sun safety, mental health and substance misuse to young people, their parents and volunteers.

The events series was launched in January with a community 16k challenge and 5k fun run.

This event attracted 115 runners and walkers, and participants were encouraged to continue with a physically active lifestyle.

It was closely followed by a fun healthbased table quiz for children and parents which was supported by transition year students from Mercy Secondary School, Longford.

The youth club facilitates and encourages

activities such as badminton, table tennis, chess, draughts and art so that children can develop their own interests.

Leslie Finan, AGM committee member says: “It is important that children are encouraged to do + AGM Longford on course for promoting healthy events. L-R, back: Leslie Finnan, AGM what they enjoy Longford; Clodagh Armitage, HSE Physical Activity Co-ordinator; Paddy McPhilips, AGM and are not pushed Longford; Catriona Hayden, AGM Longford; David Hoysted, HSE Community Games. into a sport. Not all Middle: Daniel Hayden, Cathal Farrell, Brendan Finnan, Cian McPhilips, Cian Farrell. children are sporty Front: Aideen Mullingan, Sarah McPhilips, Anna Hayden and Laura Farrell. or athletic, so we like to make sure all activities are encouraged.” as volunteers. This can only benefit the children,” she said.

Creative approach In a creative approach to teaching the Positive Effect children the importance of a healthy Dr Nazih Eldin, HSE Health Promotion lifestyle, the committee organised an Manager, said: “We were delighted to be exciting poster competition for children, the title partner of the August Festival of the with a focus on the five different health HSE Community Games. The community messages. These bright posters – with games participants and volunteers slogans such as ‘You don’t need to be throughout the country are proving to be wealthy to eat healthy’, and 'Don’t lose the ideal advocates for healthy living. your mind, mind your mental health' now ‘’We are already seeing the positive effect decorate the walls of the club. this initiative is having on the areas involved “The poster competition was a simple but in terms of greater participation, wider choice effective way to teach the children about the of games and fun and joy everyone is having. importance of their health,” added Leslie.

But with one in four of our children either overweight or obese, we must ensure that our “The healthy events awards have made us children get the best start in life. If we can help think about our health and the lifestyle choices parents to make the better choices now, this we make. We conducted a lunch box survey can really make a difference in the long term." and found that only 60 of the 102 students surveyed had a piece of fruit. This was a real Every year, the HSE Community Games eye-opener. We no longer provide fizzy drinks, partnership aims to promote healthy living crisps and sweets at any of our events and across all aspects of everyday life including while that has been a difficult transition now being active, eating well and being mindthe children are enjoying fruit and open to healthy. The HSE has been the title sponsor tasting different, nutritious snacks. of the Community Games organisation since 2006. The games are an important “If anything, the healthy event awards initiative as they encourage young people to has introduced a whole new way of live healthy and fulfilled lives. thinking, planning and enjoying our work

Health Matters 89

Humour

Feeding the mouth that bites you

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‘Dad’ is the word that switches men on. Were you ever in a crowded place when some child calls out “Dad!”?

Hundreds of fathers turn around to check if it’s their kid who’s calling them, writes Finian Murray.

T

here are times when being a father seems nothing more than feeding the mouth that bites you. I only have myself to blame; I’m too soft. I arrive home from work to find them always on the phone or waiting to be driven somewhere. It’s hard being a parent nowadays because kids want so much stuff – game consoles, mobile phones… food. I carry photos where my money used to be.

Some years ago my kids asked if they could be home-schooled. I explained that the downside of being home-schooled is that you don’t get a day off for the snow. It never came up again.

My son is 16 and is into rap music. Last autumn he said to me: “Dad, I want to get a ticket for 50 Cent.” I put my hand in my pocket and said, “Here’s a euro, get me one as well.” As it turns out each ticket cost me a62, but I brought him to the concert even though rap music scares me… y’all.

For an hour and a half I had to endure a guy walking across the stage imparting to the young people such philosophical wisdom as “Go Shawty, it’s your birthday… we’re gonna party, like it’s your birthday…”

One year we went on a family trip to Spain. Nothing compares to travelling with kids. The first day we went on a walking

tour and it was very hot and it’s like, “I need a drink, I’m tired” and “I need to go to the loo”. Finally my youngest puts her hands on her hips and goes, “Dad, stop whinging”.

Fathers work hard on a family holiday because kids want to copy everything they see. The following day we’re walking down the street and coming towards us is a little girl on her daddy’s shoulders. My daughter immediately turns to me and says, “Dad, I want you to carry me”. I say, “Ah now, c’mon, you’re 16”.

Sometimes my kids remind me of those automatic toll booths on the motorway – they refuse to accept brown money.

Kids can get obsessed with a film and make you watch it over and over with them. Don’t get me started on Bee Movie, the children’s animated film. In it plants are pollinated by a macho, elite group of male workers called 'Pollen Jocks’. I’m by no means an expert on bees but my understanding is that worker bees are female. Why doesn’t Hollywood give the ladies their credit?

In The Lion King movie, Mufasa explains to his son Simba the great circle of life. “You must respect every creature from the crawling ant to the leaping antelope.” Simba asks: “But don’t we eat the antelope?” Mufasa replies: “Yes. But when we die we become the grass and the antelope eat the grass.”

That’s a very good explanation – unless of course you happen to be an antelope.

I agree with Samuel Levenson’s quip: “Insanity is hereditary – you get it from your kids.”

“Some years ago my kids asked if they could be home-schooled.

I explained that the downside of being home-schooled is that you don’t get a day off for the snow. It never came up again.”

Finian Murray is men’s health development officer with HSE Dublin North East. He is author of a number of peer-reviewed and other publications in men’s health. His hobbies include performing stand-up comedy.

90 Health Matters

Gardening

Support your local wildlife!

John Sweeney, Manager at Plantmarket, on biodiversity and why it is critical for all our gardens. ny garden created for wildlife must offer an environment where the local ecology can feel at home. It's likely to include some grasses to provide seeds and pollen. It should also include a selection of umbellifers, such as angelica, fennel, chervil or dill – all of which are rich in nectar, and are particularly attractive to hoverflies and lacewings whose larvae, in turn, eat aphids.

Stinging nettles are essential food for the caterpillars of butterflies such as red admirals, tortoiseshells and peacocks, and therefore a must for every garden. So is all wildlife gardening about boring old weeds and hard-to-manage plants? The answer here is definitely not. Working in harmony with nature brings many bounties.

Biodiversity in the garden is a must; a fact of life.

When planting a nectar border or any selection of flowers to attract insects, think first about what's best for them, and second about what you want to look at.

The two are not remotely exclusive of one another, but there are a few basic principles to bear in mind.

For instance, single-flowered plants are a good choice, because the design of these blooms makes it easier for insects to reach the nectar and pollen. Many double flowers are inaccessible to insects, or have low amounts of nectar and pollen – sometimes even none at all.

Although many insects are inactive in winter, some will still seek nectar late into the autumn, or on a warm spring day.

Having a selection of plants flowering throughout the year can help ensure there are always nectar sources available.

In Plantmarket Vocational Training Centre, we planted the 'Nectar Bar' in autumn, with flowers such as buddleias, asters and sedums to attract insects later in the season.

The perfect lawn may please the gardener, but can be a desert for insects. So in front of the bar we laid a strip of wildlife turf, which is enriched with dozens of wildflowers and

www.thinkstockphotos.com/istock

A

many different types of grass. We'll grow it long and then cut it, as we do the wildflower meadow, just twice a year.

Behind the bar we planted a mixed hedge of native species, which as well as producing nectar will shelter the plants and insects and provide nesting cover for the birds.

Plants for life It's vital to provide flowers throughout the bumblebee's life cycle, from March to September. It's also a good idea to have at least two nectar or pollen-rich plants in flower at any one time during this period.

The nectar feeds the adult bee, while the pollen is collected to feed the young. Of course, the more flowers you have, the more attractive your garden is to bees – so you can never have too many!

Try the following to attract more bumblebees into your garden: • Spring flowers: Bluebell, bugle, crab apple, daffodil, flowering cherry and currant, forget-me-not (Myosotis), hawthorn, hellebore (Helleborus corsicus, H. foetidus), pulmonaria, pussy willow, rhododendron, rosemary, viburnum, thrift (Armeria maritima).

• Early-summer flowers: Aquilegia, astilbe, campanula, comfrey, everlasting sweet pea (Lathyrus latifolius), fennel, foxglove, geranium, potentilla, snapdragon, stachys, teasel, thyme, verbascum.

• Late-summer flowers: Angelica, aster, buddleia, cardoon, cornflower (Centaurea), dahlia (single-flowered), delphinium, eryngium, fuchsia, globe thistle (Echinops), heather, ivy, lavender, penstemon, scabious, sedum, Verbena bonariensis.

Winter wildlife Most garden wildlife hibernates over winter, as food is in short supply and freezing temperatures make life difficult. In winter, wild animals and insects hunker down in log and leaf piles, nestle into tree bark, or bury themselves in compost heaps or mud.

Some species, such as birds and squirrels, don't hibernate, but struggle to stay alive using up fat reserves just to stay warm.

Birds Birds are more likely to visit gardens in autumn and winter, as they rely on bird feeders when their natural sources of

Health Matters 91

Gardening

How to help: • Leave fallen fruit on lawns, bird tables or at the back of borders for birds to find and feast on.

• Allow teasels and sunflowers to seed, providing you with winter interest and an instant snack for birds.

• Install a bird bath, where birds can drink and clean their feathers – essential for insulation.

Frogs, toads and newts Frogs, toads and newts overwinter in log and leaf piles, or beneath stones and plant pots. Some rest in the mud at the bottom of ponds. They're also fond of compost bins, so be careful if forking over the heap.

Frogs enter a state of torpor in winter, rather than hibernation, rising from their slumber in search of food on warm days. How to help: • Float a tennis ball or similar in your pond to prevent it freezing over, reducing oxygenation and suffocating any frogs beneath the surface.

• Create a rock pile. Ideally this should face north, to avoid temperature highs and lows between day and night. If possible, site it near a pond or damp spot.

www.thinkstockphotos.com/istock

Hedgehogs Nearly half of all hedgehogs die during their first winter. Many starve, while those born in late summer are often too small to hibernate and so are unable to survive the

cold weather. In mild winters, hedgehogs are prone to waking up, having been tricked into believing it is spring. They waste valuable fat reserves looking for food.

How to help: •P rovide hedgehogs with a warm place to sleep by making a leaf pile or buying or making a bespoke hedgehog house.

Leave warm, snug compost heaps in situ until spring, where hedgehogs will rest and also find food.

•L eave a dish of water and some dog or cat food to help boost their fat reserves.

Stop feeding them as winter sets in to encourage them to hibernate.

•A lways check bonfires before lighting them, preferably making the pile on the day you intend to light it.

• I f you find a baby hedgehog in autumn, take it in and keep it warm. Feed it with cat or dog food and water, but don't release it until it weighs at least 450g (1lb).

Insects Insects readily hibernate in gardens.

Bumblebees dig holes in the ground or rest in leaf litter, butterflies sleep in garages, sheds and between folds of curtains.

Wasps, ladybirds and lacewings shelter

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insects and grubs dry up. They need calorie-rich suet, sunflower hearts and peanuts to maintain fat reserves on frosty nights. In colder weather, look out for less common visitors, such as waxwings, blackcaps, redwings and bullfinches.

under loose bark on logs and in cracks in door and window frames. If you disturb them, they're likely to perish. If you can't leave them undisturbed, move them to a cool spot where they can settle again.

How to help: •R ecreate the nooks and crannies insects hibernate in by tying up bamboo and sunflower stems, and leave them in a dry spot in the garden.

•P rovide late-flying insects with a source of food by soaking a clean sponge in a solution made from an equal mix of sugar and water.

Supporting wildlife is critical for all our gardens, our food production and our futures. Embrace it, nurture it and love it, but above all else protect it.

Plantmarket Plantmarket is one of 22 services provided by the HSE’s EVE network, which offers a range of community based training and work services for people with mental health difficulties in Dublin, Wicklow and Kildare. Plantmarket Garden and Training Centre is located at Blake’s Cross near Lusk in north Dublin and is open to the public on weekdays from 9am to 4.30pm (Monday-Thursday) and from 9am-3.30pm (Friday).

92 Health Matters

Commercial Profile

Omega-3 Health Claims Proven Eskimo-3, an omega-3 rich oil, is clinically proven to lower triglycerides and blood pressure.

O

mega-3 fish oils have been the fastestgrowing segment in the natural healthcare market over the last ten years. This growth is based on increasing general awareness of the benefits of omega-3 in the context of cardiovascular health and brain function.

Historically it was thought that EPA was the omega-3 which conveyed all the protective cardiovascular properties, but recently DHA has been found to have its own independent, unique properties – for example, DHA on its own has been shown to lower triglycerides.

DHA is prominent in the new approved health claims: • DHA contributes to the maintenance of normal blood triglyceride levels – 2g daily.

• DHA and EPA contribute to the maintenance of normal blood pressure – 2g daily.

• DHA and EPA contribute to the maintenance of normal blood triglyceride concentrations – 2g daily.

Formulated by renowned Swedish cardiologist Tom Saldeen, Eskimo-3 (with EPA and DHA) has been clinically proven to reduce triglycerides by 64 per cent and increase HDL cholesterol by 21 per cent in six months. Participants were given 15ml Eskimo-3 daily, which contains more than the recommended 2g EPA and DHA as recommended by the EU. Eskimo-3 is an omega-3 rich oil of legendary purity, freshness and stability, from sustainable sources with full traceability and quality control.

Eskimo-3 is available in your local health food store or pharmacy!

www.facebook.com/eskimo3ireland

Health Matters 93

Breastfeeding

Breastfeeding: A Good Start In life Breastfeeding support groups aim to guide, support and assist mothers in their breastfeeding experience and help them to build on their own knowledge and confidence, write Helen Coyne and Vivienne Goodwin, both public health nurses and International Board Certified Lactation Consultants.

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reastfeeding is normal, natural and very rewarding. Some of the factors that affect women in breastfeeding are lack of support in their choice, lack of guidance and reassurance, and a lack of advice from other breastfeeding mothers.

Breastfeeding support groups have been known to increase the overall rates and satisfaction of breastfeeding, and lead to some lasting friendships. Mothers may find they form an alliance with other mothers and experts with each meeting.

The psychological factors in breastfeeding are challenging and we can only hope to help mothers along the way. Learning without any pressure or discomfort is key.

One woman's poor experience can hinder sisters, friends and colleagues as word of mouth spreads. However, if we can ensure they are supported and comfortable, we can encourage more mothers to breastfeed.

North Dublin has a long tradition of supporting breastfeeding mothers. Public health nurses (PHNs) visit all mothers who have given birth, within 48 hours of being discharged from hospital. They provide

+ Vivienne Goodwin, Public Health Nurse, supporting new mum Peggie-Anne and baby Mabel.

accurate, professional information and emotional support in breastfeeding and parenting experience. New parents are also given information on local PHN-facilitated breastfeeding support groups, community mother support groups and voluntary organisation breastfeeding support groups such as those run by Cuidiu and La Leche League, etc. Locations for breastfeeding support groups are listed on Breastfeeding.ie.

Over the past few years the North Dublin Breastfeeding Support Audit Group has undertaken customer satisfaction surveys on HSE breastfeeding support groups in north Dublin. For example, some of the feedback from mothers found that certain HSE venues were inappropriate for group sessions, and so PHN teams in Swords and Lusk both sourced alternate venues to host the support groups, which are now running successfully.

PHN clinical clubs are held regularly for staff in order to increase staff awareness on

The Ten Steps The ten steps we follow as a support team are simple and straightforward, and allow us to communicate, encourage and support each member of the group. They summarise the maternity care practices known to effectively support breastfeeding.

• Have a written breastfeeding policy that is routinely communicated to all health care staff.

• Encourage breastfeeding on demand.

• Inform all pregnant women about the benefits and management of breastfeeding.

• Help mothers initiate breastfeeding within one half-hour of birth.

• Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.

+ Mothers and babies attending the Lusk Breastfeeding Support Group.

breastfeeding issues, and to standardise information given to mothers. We have a long history of engaging and rewarding breastfeeding support groups in north Dublin, facilitated by enthusiastic and helpful public health nurses with many years of experience.

Breastfeeding – A Good Start In Life is the theme of National Breastfeeding Week 2013, which takes place from October 1st to 7th.

For more information go to www.breastfeeding.ie.

•G ive newborn infants no food or drink other than breastmilk, unless medically indicated.

•P ractice rooming in – that is, allow mothers and infants to remain together 24 hours a day.

•T rain all health care staff in skills necessary to implement this policy.

•G ive no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

•F oster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

(Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services, a joint WHO/UNICEF statement).

94 Health Matters

Breastfeeding

Every breastfeed makes a difference New mother Monica Devine talks about how some early breastfeeding hiccups were quickly overcome with the support of the other mothers and the public health nurse at her local breastfeeding support group.

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ne of the girls gasped: “What on earth is that!?”. “Eh…that’s my milk shoot”, I replied. “Do you all not have them?”

It was my first day at the breastfeeding support group (BFSG) at the Mornington Resource Centre and my daughter Lily Rose was two weeks old. I was struggling to breastfeed her and really needed some friendly advice.

My fellow mammies at the BFSG and Helen, our supportive public health nurse (PHN), quickly helped me understand that I had an oversupply of milk. They gave me tips to help remedy my situation including block feeding and anti-gravity feeding positions. I was able to put these tips into practice that very day, which was exactly what I needed.

That’s the beauty of a BFSG I suppose – invariably there’s a mammy there who is a few weeks or months ahead of you who has had a similar experience with breastfeeding and can offer on-the-spot advice, backed up by the expertise of a PHN like Helen.

The BFSG, or the “Boob Club” as it became affectionately known by my peer mammies, really was the making of my maternity leave. With them, I had my first nervous nursing-in-public (NIP) moment in our local park. Getting to know a group of local mammies had all sorts of knock-on benefits. Outside of the weekly Boob Club official meeting we went on weekly walks together, trips out for lunch and went to mammy and baby swimming classes. We helped each other with breastfeeding of course, but we also supported each other with all other new parenting challenges, including the seemingly never-ending fatigue!

+ Copyright 2013, Giggles and Smiles Photography.

Irish Milk Bank Although we had joked initially about my 'milk shoots', once the BFSG had helped me cope with my oversupply they then encouraged me to put my supply to good

use and to donate to the Irish milk bank. I donated a couple of times to the bank and it felt good to know that Lily Rose’s milk was helping other tiny babies around the country.

I’m long back at work now and yet my bond with the BFSG continues. I drop back to the group if I’m off on a Wednesday and try to offer some support to the new mammies there – as I found the support from mammies with older babies so inspiring during those hairy first few weeks.

I’ve also made some long-term friendships with mammies from the Boob Club, and we often meet up now. It’s wonderful to see our babies grow up together and many of them are still nourished by their mammy’s milk.

We are all extremely grateful for the support we received from our BFSG and no doubt it has made the “mammy miles” we have earned so far all the more enjoyable as we travelled them together.

96 Health Matters

Breastfeeding

Alcohol and Breastfeeding: Reviewing the Evidence Rates of breastfeeding in Ireland have increased by seven per cent in the past few years, but figures from 2012 show that just 56 per cent of mothers initiate breastfeeding in Ireland compared to over 90 per cent in Scandinavia and more than 80 per cent in the UK.

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iven the positive health benefits of breastfeeding for both mother and child, a commonly asked question is whether or not mothers should drink alcohol when they are breastfeeding. Dr Tanya Cassidy won a Health Research Board Cochrane Fellowship to examine this important issue and investigate what evidence is available on the subject of alcohol consumption during breastfeeding.

She and her co-researcher, Dr Roslyn Gilgia from Curtin University in Perth, looked at all the research that has been done on this topic globally and are currently collating what they have found in order to present evidence-based conclusions later this year in the form of a Cochrane Review.

“It’s a complex area,” says Cassidy.

“Research on the effects of alcohol has to take account of a multitude of factors, such as how much alcohol is consumed, the mother’s pattern of drinking, the time interval between ingestion and nursing, and the age of the infant.

“Mothers and expectant mothers are understandably eager to receive guidance and informed advice from their healthcare advisers and providers about breastfeeding ‘dos and don’ts’, she says. “Alcohol consumption among mothers following birth is one such topic, and it has fuelled its fair share of controversy. In the western world, the consensus advice suggests that abstinence during breastfeeding offers the best health outcomes.”

Research “Our review of evidence reinforces some well-known facts,” she says. “For example, we know that what a mother eats and drinks affects the taste of her milk and that alcohol produces odour and flavour changes of the milk, which can lead to heightened nursing concerns.

“But our work also introduces some things that we wouldn’t know so well. For example, alcohol impairs the process by which muscle cells in breasts squeeze out milk. One Taiwanese study we looked at found that women who consumed chicken soup flavoured with rice wine experienced a significantly longer time regarding milk ejection. These biological delays regarding the release and volume of milk can have direct effects on infants, and can lead to decisions to introduce formula feeding, but more research is needed in this area.”

Naturally, a shift to formula feeding is not something one wants to see happen, as research shows that health outcomes, including issues such as infectious morbidity, childhood obesity, type one and type two diabetes, leukaemia and sudden infant death syndrome are substantially different among mothers and infants who formula feed compared with those who breastfeed.

“We found a particularly interesting example of a randomised control trial concerning alcohol and breastfeeding: the American Healthy Moms study,” she says. This study identified high-risk alcohol-consuming women and randomly assigned them to receive a brief educational intervention from their health care provider or not – and found, through longitudinal interviews, that the group receiving the intervention was substantially more likely to reduce their alcohol consumption.

Another American study argues that digital intervention is also useful, but did not concentrate on breastfeeding mothers.

Other Factors “We also found socio-economic factors influence decision making,” says Cassidy.

Research has demonstrated that women who consume alcohol during lactation are not necessarily women considered

+ Dr Tanya Cassidy.

by health professionals to be at high risk of alcohol intake. The Norwegian, New Zealand and Australian data all indicate an association between alcohol intake during lactation and a higher level of education and household income. Women with a higher education level and income are the women most likely to breastfeed, but these also seem to be women who are more likely to consume alcohol daily, having direct effects on their breastfeeding.

“As we worked our way through the available data it was clear that many studies mention the issue of alcohol and breastfeeding as an extension of pregnancy.

There has been limited work on alcohol and breastfeeding specifically. This is not surprising, given the complexity of the issue, never mind the social and cultural barriers around the accuracy of self-reported alcohol consumption and the inherent pressures on any mother to play down her level of alcohol consumption in order to meet perceived cultural expectations.

Health Matters 97

Breastfeeding

www.thinkstockphotos.com/istock

“However, when we look at what women of child rearing age actually do across the world, anthropologists and other researchers have found that alcohol consumption in women of child-bearing age appears to be the cultural norm,” says Cassidy.

In the United States, alcohol consumption rates for women of child-bearing age are over 50 per cent. Public Health Canada reports that roughly 75 per cent of women of childbearing age reported using alcohol in the previous 12 months. In Australia, over half of adult women under 50 reported consuming alcohol on a weekly basis and almost a third had consumed alcohol on a daily basis.

In Ireland, a study of women who attended the Coombe Women’s Hospital found that almost two thirds (63 per cent) of the 43,318 women surveyed said they drank alcohol during their pregnancy. The situation is put into stark relief when the number of women who stopped drinking during pregnancy, 13.2 per cent, is contrasted with the almost 50 per cent who gave up smoking.

In Australia, the government has recently issued recommendations that nursing

mothers should avoid alcohol consumption completely until after the baby is one month old. Given that small amounts of alcohol have a greater effect on younger infants, this is not surprising. They also recommend not consuming alcohol shortly before feeding, not to consume more than two units per day if you are to drink, and not to drink every day. It’s a balancing act that addresses the reality: a lot of women in the modern world are in fact social drinkers. “If you tell mother not to drink at all it might discourage them to breastfeed in the first place, or it may influence a decision to end breastfeeding early,” says Cassidy. “The advice recognises that breastfeeding rates are generally low and that on a population level there are societal benefits if more babies are breastfed for longer than is currently the case.”

Ireland It is notable that Ireland has one of highest rates of alcohol consumption in Europe, and one of the lowest breastfeeding rates.

Somewhat encouragingly, though, the national breastfeeding survey showed

that only a small number of women stated explicitly that they stopped breastfeeding in order to be able to drink alcohol. In Northern Ireland however, similar research found that some of the mothers they interviewed never started to breastfeed so that they might accommodate a drinking lifestyle.

“It is clear that there are many factors that influence or determine choices in relation to alcohol consumption and breastfeeding,” says Cassidy. “We would hope that our review would provide clear evidence to inform decision making for everyone’s good. We hope to publish the full results of our analysis before the end of the year.”

As with all Cochrane reviews, this study will be available from the Cochrane Library, which everyone from the island of Ireland can access for free. This arrangement is sponsored by the Health Research Board and its Northern Ireland equivalent.

Dr Tanya Cassidy is a medical sociologist affiliated with the Anthropology Department at NUI Maynooth. Dr Cassidy has extensive expertise in researching alcohol and gender-related issues.

98 Health Matters

Dialysis

Art Project Celebrates A Year in Dialysis An exhibition titled A Swallow’s Tale in a Thousand Skies, which was held in the Galway Arts Centre in August, proved to be the highlight of an art project celebrating a year in dialysis at Merlin Park University Hospital, Galway.

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n 2012 the Arts Council awarded Galway University Hospitals Arts Trust an Arts Participation Project Award for visual artist Marielle MacLeman to work with dialysis patients at the hospital. The artist worked with patients while they were on dialysis and provided staff workshops during lunchtimes, culminating in a range of artwork including paintings, temporary sculptural installations using icing sugar and paper, as well as designs for the refurbished waiting area of the dialysis unit.

An affinity with the Irish landscape, traditions and language was apparent in the conversations and artwork of both patients and staff throughout the project. Reflecting this, an illustrated storybook called The Magician and the Swallow’s Tale was made by participants. The book describes the project’s development through the seasons and contains the things that matter to project

Artist Marielle MacLeman Marielle MacLeman is a visual artist born in Scotland and based in Galway.

She studied drawing and painting at Duncan of Jordanstone College of Art and Design, Dundee, and works across mixed media wall-based work, objectmaking and site-specific installation.

Her practice includes working in community and healthcare contexts.

Initially specialising in palliative care she wrote the book The Pattern of a Bird, published in 2008 by Art in Hospital, Glasgow. She has exhibited in the UK, Ireland and Italy and has received awards from the Scottish Arts Council, Glasgow City Council, Arts Council of Ireland and Galway City Council as well as a Per Cent For Art public art commission.

participants. Parts of the book have been translated into Irish by patients and staff.

The exhibition and accompanying book showcase a selection of beautiful artworks, designs for crockery and fabric, gardening tips, songs and stories of Connemara, as well as insights into the anglers’ art of fly-tying.

“The project was a year-long programme of creative interventions which sought to physically enhance the clinical environment and to celebrate the ephemeral things that humanise it,” explained artist Marielle MacLeman. “Above all, participative workshops offered patients more positive, productive experiences during dialysis.”

According to Margaret Flannery, Arts Director, Galway University Hospitals Arts Trust, “This is a truly special and unique project. In the book, Marielle describes the participants’ journey beautifully, intertwining their stories and experiences as the project progressed and the artists gained confidence.”

A More Interesting Place Maria Geraghty, Clinical Nurse Manager is also a fan. “This project has certainly made Unit 7 a more interesting place for both patients and staff. It has given everyone something different to talk about and brought out a very creative, artistic side to patients and staff alike. Rather than just discussing their health issues, patients and staff are now discussing how their art projects are coming together – a welcome distraction from the day-to-day routine of the dialysis unit which is so important for mental and emotional wellbeing. You wouldn’t even know Marielle was here sometimes, she just fitted right in. On the Sunday after the exhibition, one of the nurses said that all the talk and laughter amongst the patients was about the book launch and exhibition, and she thought to

+ Lorna Durack, Dialysis Nurse, GUH with her daughter Alice.

herself how proud she was of them all and felt 'isn’t this a great place to work' – now that’s something!”

Siobhan Connolly is a patient participant from Clarinbridge, Co Galway. She met her partner, Gerry Wallace from Gort in the Merlin Park unit. “Marielle gave me great encouragement,” she said. “It is brilliant and a great way to pass time, as it can be a long time on dialysis and dialysis can be very tedious. You are spending so many hours of your life in hospital, so it’s wonderful to have an opportunity like this.”

Project participant Colm Walshe observed: “It has added a lot to the dialysis unit, this art project. I have been on dialysis for years, with nothing to do, no television and no-one to talk to, only the patient next to you who might be sick. Now, when you are four hours on dialysis, it is great having someone to talk to, whether it is an artist, a nurse or whoever. It passes the time and it takes your mind away from it. Now in the evening when you come off the dialysis you are looking at the artwork and see what the participants have achieved. You can see the patients looking at their own work and see how delighted they are with it.

“I’ve watched participants make work – brilliant art that they did not realise they

Health Matters 99

Dialysis could do. That must be fantastic for the ego. There are some beautiful paintings in the waiting area. Every little improvement to our environment makes the experience of dialysis a little easier. So I think it is a brilliant project and long may it continue.”

Engaging People Visual Artist Marielle MacLeman worked with the dialysis patients, their families and staff from the unit during the year.

“I’ve worked in healthcare as an artist for over ten years but working in dialysis is as challenging as it gets,” she said. “It has been interesting for me as an artist; looking at ways of engaging people creatively that is not just painting. Conversation is a lot of what you do to find the right road in and the appropriate way of working and to gain the trust that you need to. As you are encroaching on people’s private space, you are aware people are unwell or have other things going on in their lives and you have to be respectful of that. When it is right it can be an extremely productive and positive experience for people.”

Care Assistant Marie Lane is another project participant. “I have so enjoyed the experience,” she said. “For someone who never painted, when I look at my painting I am so proud of it. But mainly, it has been so beneficial to patients. It has given one lady in particular something more: given her confidence, happiness and excitement. It has been great. We are all interacting and chat more.”

Captured In Print The project was also accompanied by an illustrated storybook, The Magician and the Swallow’s Tale. “The project never set out to create a book, but from the conversations in the unit and interactions it seemed the most logical way of capturing the ephemeral moments between patients and staff,” said Marielle MacLeman.

Margaret Flannery, Arts Director added: “In the book, patients and staff are portrayed as something other than the daily roles they play on a dialysis unit. Their interlinking stories are woven together through dialogue, artwork and characters including The Woman who Painted Western Shores, The Cake Decorator, The Box Player and The Woman who Dressed Dialysis.”

The project won the praise of David Lappin, Consultant Nephrologist. “I think that art plays a very important role in

+ At the launch of the A Swallow’s Tale in a Thousand Skies exhibition and accompanying book, front row from left: Dr Yvelynne Kelly, SpR Nephrology and dialysis patients Maureen Burke, Una M Lawlor and Luke Coen.

Back row: Pat O’Brien, Chair of the Arts Committee and Medical Safety Co-ordinator, GUH; Dr David Lappin, Consultant Nephrologist, GUH with his son Henry Lappin, and Ann Cosgrove, General Manager, GUH.

healthcare,” he said. “The purpose of this project was to introduce art to patients and staff in the dialysis unit, to improve the atmosphere and overall general environment of the dialysis unit and see if we could improve the quality of life for patients attending dialysis. Life on dialysis isn’t an easy life; sometimes we fail to recognise that and when the patients have other activities to do such as the arts it helps to pass away the long hours they spend on dialysis. It also gives staff another level on which they can interact with patients and make the whole unit more

human, as it is a very clinical environment.”

The project is generously supported by the Arts Council, Galway University Hospitals, Galway University Hospitals Arts Trust, Galway Arts Centre, the Irish Kidney Association, Galway City Council and Galway County Council.

The Magician and the Swallow’s Tale will be disseminated to all dialysis units nationally and is available for sale from Galway University Hospitals Arts Office for a10. Further information from Galway University Hospitals Arts Trust at (091) 544979 or Margaret.Flannery@hse.ie.

Galway University Hospitals Arts Trust Galway University Hospitals Arts Trust runs the west of Ireland’s leading arts and health programme as a means of improving the hospital experience for patients, visitors and staff. The Arts Trust believes access to the arts promotes wellbeing and enhances the hospital environment. In providing a multi-disciplinary programme of events and activities that integrate the arts with the health care setting, the Arts Trust promotes greater links between the hospital and the community.

Celebrating its 10th anniversary in 2013, the Arts Trust’s programme includes exhibitions, participative workshops, music, theatre and poetry. The exhibition programme includes the annual staff art exhibition Art@work, on the Arts Corridor in University Hospital, and partnerships with Galway Arts Festival and Tulca Festival of Visual Art. The Arts Trust also partners with Cúirt International Festival of Literature on Poems for Patience, which are displayed throughout hospital waiting areas. The exhibition programme is complemented by participatory arts workshops with visual artists and creative writers in residence, interactive events by drama practitioners and music recitals.

100 Health Matters

Volunteering

Beaumont staff help in Malawi Beaumont Hospital staff members Clodagh McHugh and Paul Troy travelled to Malawi to deliver training in cancer care nursing. They tell Health Matters about their experiences.

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alawi is among the poorest countries worldwide: it ranks 170 out of 182 on the UN human development index scale. It has a huge human resources problem, particularly in the health sector. It ranks last on the WHO list of estimates of health personnel, with two doctors and 38 nurses per 100,000 people (WHO 2010).

In comparison, Ireland has 310 doctors and 1,310 nurses per 100,000 population.

There are no cancer statistics available for Malawi, but like all middle and low-income countries the incidence has increased significantly in recent years.

Paul had worked in Malawi for two years previously with international development charity VSO, lecturing in nursing in one of the country's two universities. During this time he had made contact with the country’s only oncologist, Dr Masamba. While talking to Dr Masamba during Malawi’s constuitional crisis in April 2012, he requested training for nurses working in the oncology unit. After some discussion and having managed to persuade Clodagh to become involved, we agreed to go for one month. This was all our annual leave allowed.

Prior to our departure we liaised with the Sr Naomi, nurse in charge, and Dr Masamba to identify the training needs there. We then devised a four-week programme which would include the fundamentals of cancer care. The oncology course co-ordinator in Beaumont Hospital gave us access to some of the lectures delivered on the postgraduate diploma in oncology nursing. These were modified to cater for local knowledge and resources.

Limited facilities Queen Elizabeth Central Hospital (QECH) is the country’s main referral hospital. It is a 1,000-bed facility, often accommodating up to three times this number of patients at any one time. Despite being the country’s main referral hospital, facilities were very limited.

+ Clodagh McHugh with some of her Malawian colleagues in Queen Elizabeth Central Hospital.

The oncology ward, which was called 2A, had 35 beds. Frequently there were up 60 inpatients in the ward at any one time.

Most of these were in a large and open ward, often occupying just a mattress on the ground. A four-bedded room also served as an examination area. Chart storage was converted daily into the day ward along with a corridor adjacent to it.

The only three single rooms were used for neutropenic patients. The treatment room also served as the chemotherapy preparation room. This contained none of the necessary safety apparatus for cytotoxic reconstitution. There were only seven nurses available for this service.

We were warmly greeted by the nursing staff, who were very eager to avail of this educational opportunity. Currently there is no training in cancer nursing available in Malawi. Paediatrics, midwifery and public health are the only postgraduate programmes available and these are only

available to registered nurses. Most of the country’s nurses are enrolled nurses or nurse technicians.

For example, one of the nurses had qualified in 1968 – and this was her first opportunity for further training. Dr Masamba has also arranged for nurses from the two private hospitals in Blantyre to undertake the training. After spending the first day observing, we decided that we needed to alter our pre-planned programme. It was apparent that we needed to focus on basic safety issues concerning chemotherapy storage and reconstitution, chemotherapy administration and disposal.

The nurses’ role involved the preparation of chemotherapy – consequently, they were exposed to cytotoxics as they lacked the proper equipment and protective clothing.

Safety Fears We identified real safety concerns for staff and patients concerning spillages and

Health Matters 101

Volunteering extravasations. During our four weeks, we delivered a programme aimed to equip the nursing staff with the practical skills and knowledge to deliver safe and effective care to the cancer patient. We divided our attentions between the inpatient and outpatient service. Our day involved working very closely with the nursing staff. Our initial focus was on enhancing safer preparation and administration of chemotherapy. Following on from this we looked at patient assessment and education, and the management of chemotherapy-related side effects.

We also developed a structured approach to managing their outpatient service – as there was no pre-booking of patients, which led to a somewhat chaotic day unit. Our daily lectures sought to develop their knowledge base in relation to specific cancers and associated treatments. We took into consideration the most prevalent locally-treated cancers (kaposi sarcoma, cervical cancers, HIV and HPV-related cancers, lymphoma) and the treatment available for them.

Oncology reference books and a laptop containing the lectures along with oncology resource material were donated to the nursing and medical staff to facilitate further education of staff. In conjunction with the oncologist, we devised a chemotherapy administration record and guidelines for managing febrile neutropenia, chemotherapy spillage and extravasation.

Challenging environment The environment was challenging – overwhelming at times, but it has given us a fresh appreciation of the Irish healthcare system.

Treatment for patients was free, but not all chemotherapies were available, resulting in patients receiving only part of certain chemotherapy treatment regimes.

Radiotherapy was not available in the country. Essentials such as syringes, gloves and IV fluids were in very short supply.

Many anti-emetics were unavailable.

The laboratories were often unable to do essential blood tests – for example FBC, U&E – due to a lack of reagents. Patients were requested to return the following day when this happened.

With 80 per cent of the population living on less than a dollar a day, affording transport to the hospital alone was difficult. Nurses, however, worked in this

environment with admirable patience and generous smiles for very little remuneration.

They were often relied upon to cover a 24-hour shift. We learned much from our Malawian colleagues and we are very impressed at their enthusiasm to develop their service to cancer patients.

With money from friends and well wishers, we managed to purchase a fridge for the storage of chemotherapy. With some negotiation we managed to have an unused room adjacent to 2a opened.

Using the remaining monies we had chairs and benches made by a local carpenter, ensuring the room was transformed into a functional day ward. We left feeling we only tipped the iceberg.

We thoroughly enjoyed our experience in Malawi and enjoyed the stunning beauty

of a national park and Lake Malawi at the weekends. On our route home, we soaked up the delights of Kenya for three days before returning to work in Beaumont Hospital.

Since returning we have continued to foster links with our nursing colleges in Malawi. We have managed to enrol four nurses in an online cancer nursing programme with Alberta Cancer Centre, Canada. We recently attended the launch of Esther Alliance Ireland, and hope to use this resource to help us develop and enhance cancer care at QECH in partnership with our Malawian colleagues.

Clodagh McHugh is an Oncology Liaison Nurse in Beaumont Hospital and Paul Troy is a Clinical Nurse Manager 3 at Oncology Services in Beaumont Hospital.

ESTHER Partnerships ESTHER Ireland partnerships are already showing "very encouraging results", according to Minister of State for Trade and Development, Joe Costello TD, who launched the ESTHER Ireland programme on June 26th.

Speaking at a launch event in the Royal College of Surgeons, Mr Costello said: “Partnerships such as [ESTHER Ireland's partnerships] will contribute to major, sustainable improvement to health systems in those countries which are most vulnerable.

They will also benefit Irish health professionals, who will gain invaluable experience and new skills."

ESTHER Ireland, which is part of the broader European ESTHER Alliance, facilitates partnerships between Irish hospitals and health-related institutions with institutions in the developing world. It was established in 2012 and is an initiative under a memorandum of understanding between the HSE and Irish Aid. See www.esther.ie for more information.

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Health Matters

Per Cent For Art: The Work Of Mark Ryan

104 Health Matters

Per Cent For Art

Sculpting A Better Healthcare Environment In this issue of Health Matters we profile the work of designer turned sculptor Mark Ryan, whose sculptures are featured in hospitals, education centres and public areas around the country. Mark talks to SeĂĄn Travers about how he got involved in the Per Cent for Art scheme, what inspires his art and how art can have a positive effect on mental health.

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ark Ryan is one of the more prolific artists whose works feature in Irish healthcare facilities under the Per Cent For Art scheme. Having begun his career as a designer following his graduation from the National College of Art and Design, Dublin in 1986, he has since gone on to become an in-demand sculptor with an impressive client list that includes the Department of Foreign Affairs, the Department of Education and University College Dublin. He is also the winner of a number of bursary awards including the Hallward Gallery Sculpture Prize in 2009 and the Eigse Carlow Braun Prize for Work of Outstanding Merit in 2005.

Mark's works can be enjoyed across the island – including his striking 'Open Volumes' sculpture on the Balbriggan Roundabout in County Dublin and his liturgical sculptures in st Damian's Chapel, Ballsbridge, Dublin. His work has even spread to international shores, with his sculptures 'Wild Flower' and 'Leaf Motif' found outside their respective Irish embassies in Toronto, Lisbon and The Hague. Mark currently operates from his art studios in Clonmore, County Carlow where he lives with his wife, fellow artist, and some-time collaborator Maree Hensey.

Mark has been heavily involved with the Per Cent for Art scheme and his work is featured in HSE buildings such as Tallaght Hospital and St Vincent's Hospital in Fairview, Dublin.

Initially, Mark began his career as a designer, a profession he worked in for many years. About 15 years ago he decided to switch to working as a sculptor, feeling it would be more involved: he could acheive a "more direct method of expression" and operate in a medium where he could create and work more closely

+ Mark Ryan outside his studio in Co Carlow.

Health Matters 105

Per Cent For Art with materials, scale, form and texture in his project work. Mark became involved in working for the Per Cent for Art scheme, beginning with a primary school in Diswellstown in Castleknock. He has since gone on to do work for around a dozen schools.

Working With The Scheme "A lot of Per Cent for Art work is driven by the architect," explains Mark. "The architect would often inform the client that it was available. In some instances you can apply and it would be an open submission. The client would invite people to send in images of their work and they would shortlist people to maybe three or four. The artists would then be asked to come up with concepts and present them to the school.

We ended up working with the school in Diswellstown for a period of four to five months to develop a sculpture for outside the school. Once you had a couple of these [Per Cent for Art projects] under your belt, you became more accessible and the client can be rest assured that you have a proven track record in bringing the project to a successful conclusion. A lot of my work I have done in schools, but I have also done work with the HSE, OPW and UCD among others."

Mark's Tallaght and Fairview sculptures both respresent the Tree of Life. "For the Adelaide and Meath Children's Hospital I was approached by [Arts Officer] Hilary

+ 'Tree of Life': Adelaide and Meath/Tallaght Hospital.

Per Cent for Art commission.

+ 'Rotating form': Charles Institute, UCD Belfield. Per Cent for Art commission.

Moss as well as the visual artists there," says Mark. "They wanted a strong visual in the pastoral care centre for people because it's at the end of a long corridor and they wanted to draw people down to it. The Tree of Life was a concept I came up with. I wanted to do something in bronze because there would be nice warm lighting from it.

The Tree of Life was quite revelant to the hospital, I felt – I also added five fruits to that, which represented the five senses. It was a focal point for the hospital but it was also something of a contemplative piece."

Mark also produced a similar design for St Vincent's: "We again went for the Tree of Life. It was done a bit larger and it's up in bronze on the first floor lobby circulation area and spread out over three walls. It is a visual focal point that people would be drawn to because in places like hospitals and the healthcare units, the materials can be quite harsh. They have lino floors, stainless steel and unusual smells and sounds that can make people quite apprehensive in that environment.

"I liked the idea of using warm bronze as something people could relate to.

Something from the outside, like the tree, was brought inside. The tree is an appropriate image because it goes across all sorts of people's backgrounds due to its association with growth, roots and the free-flowing lines in it, making it quite the antithesis of hospitals. The theme was universal without being too graphic. The pieces were slightly abstracted, and slightly stylised."

Inspiration Strikes On his own inspiration as an artist and what inspires him to do the work that he does, Mark contemplates: "When I started off doing my own work, I had a section of my mind for artistic statements I wanted to make and exhibitions I wanted to do.

In order to make a living, I started to get onto the Per Cent for Art scheme. They tended to be a little bit more prescriptive because sometimes there's a definitive brief stipulated."

Mark now enjoys the balance of working alone and collaborating with others. In his studios in Co Carlow he does some work on landscapes, often with agricultural or working life themes. This, balanced with the Per Cent for Art scheme, allows him to earn a living and do more collaborative works while still getting time for more reflective works.

"You're responding to an environment such as a hospital or a public building," he says, "so they tended to be two different types of arts. When I was working with schools, Maree and I would work with the children to develop an idea and that was much more process-led. Rather than simply saying, 'you're going to have a giant sculpture outside', we actually found out what their interests were.

"Nowadays so many schools are multicultural and there are many backgrounds blending together, which tends to reflect on the school and inform the piece.

Also, it allows people who are involved at an early stage to take ownership of the project and their input into it. The days where a

106 Health Matters

Per Cent For Art sculpture was dropped off the back of a lorry without any collaboration are gone and I like that... the fact that working with people allows me to develop new ideas. Now I've found that the two sections of my mind have amalgamated into one. The work that I'm doing now is more organic and I can now look at my work differently and see it as a response to something. I think that is very important."

Art and Rehabilitation In a healthcare environment which can often be an intense or worrying environment for people, Mark is a strong believer in art being an important part of a healthcare environment. "Quite apart from the areas of art therapy which I find very important and very effective, I think art in a healthcare environment is an attempt to ameliorate some of the more difficult things about being in a hospital. It's a stressful environment. I feel if I can bring something in from the outside that people are familliar with, that art will give people a warmer, more comforted feeling than otherwise.

"It's a diversion too; it makes the environment richer. It gets people to reflect a little bit. I notice in Beaumont Hospital now, they have a lot of paintings commissioned over the years. I think it's quite nice to have a look, and in particular I like that these places are a little oasis where people can sit and talk and look at something that's unusual for them."

Mark believes that art can have a positive effect on our own mental health and for connecting people. "We've done a lot of work in housing estates. I worked for RESPOND and they developed a housing estate in Athy. There was private housing alongside accommodation for Travellers, there were people from social housing in Athy and in Kildare and they were putting them all into this housing estate. We received a commission to make a sculpture although we didn't actually present anything concrete. The idea was that we would work with the people and the process would bring people together, so we conducted numerous workshops with the people involved. I did some for men in the mornings and Maree did some with women in the afternoon. People got to know each other and we ended up developing a piece of sculpture outside and we also made a book for them. I think it is quite an important means for connecting people and I think that's the case as well in the healthcare environment."

So what does Mark think of the Per Cent for Art scheme overall? "I think Per Cent for Art is a fantasic scheme," he says. "It's fantastic for those who use the buildings and it's fantastic for us as artists because it gives us a way of earning a living, which is great! The process, sometimes, I think is quite difficult because you have to put a lot of work into getting a commission and you mightn't always get there. You have to come up with an idea in a certain amount of time and you mightn't always get it. It's a bit of a lottery that way."

Mark hopes that the scheme might receive more attention in the future from businesses and potential clients, which would lead to more visually-appealing

public venues and more work for aspiring artists. "I'm not too sure if enough people are aware of it," he says. "I know within the HSE, they have their own architects who have their own teams that look after things of this nature; they would be aware of it. Often, you come across peope who have no knowledge and are in charge of large schools. It's never been mentioned to them and it's such a shame. It would be particularly beneficial these days when work has really started to quieten down. I think it is a very worthwhile scheme."

For now, though, Mark Ryan's sculptures are already an integral part of many healthcare environments – another success for the Per Cent for Art scheme.

+ 'Fuinneamh an tsaoil': Gallen Community School, Co Offaly. Per Cent for Art commission.

Health Matters 107

Volunteering

Pilgrimage Memories Second year Letterkenny IT mental health nursing student Raymond O'Sullivan recently travelled to Lourdes as a volunteer with the Irish Pilgrimage Trust. He tells Health Matters about his experience.

M

y time as a student nurse has involved a lot of hard work and sacrifice, just as it has been stimulating and fascinating in equal measure. What I enjoy most about being a student nurse is that no day is ever the same; there are so many opportunities to learn and experience in a variety of settings. It has provided me with challenges that I never would have envisaged before I began my studies.

I chose to study mental health nursing because it is a profession that has always interested me and I am passionate about supporting and caring for people with mental health issues. I am always eager to challenge the stigma and negative attitudes that still exist, as well as being an advocate for those suffering with mental health problems.

I have always been interested in initiatives that offer opportunities for helping young people so when the opportunity arose to work as a volunteer for the for the Irish Pilgrimage Trust, I applied for a position.

Fortunately, I was one of a number chosen.

I was assigned to group 175, which is based on the east coast of Ireland.

The guests that we were assigned to look after included young people who had a medical illness, a disability, or came from a disadvantaged background. I count myself very fortunate that I had the opportunity to spend a week with these amazing people.

Though they faced difficult circumstances of one form or another, their zeal and zest for life was infectious. The memory of smiles and hugs from the guests whom I encountered will stay with me forever.

The other volunteers were also a real support for me as we developed a very friendly relationship that allowed us share experiences and stories, craic and laughter, which helped to develop a very deep sense of camaraderie. The experience also helped me to realise that the nursing profession is the best career I could have chosen: I felt so comfortable in those surroundings and being part of a group that worked to help and care for the guests under our guardianship.

+ Raymond O'Sullivan (left) with Sean Barrett, Castleknock, Dublin.

The week spent with the Irish Pilgrimage Trust in Lourdes provided me with opportunities to grow, develop and advance as a nurse and to help make a difference in someone else’s life.

These experiences helped to provide me with skills learned outside of my nursing degree, such as working with people with various disabilities, being part of a group which encompassed many different professions and backgrounds, providing 24-hour cover – and learning to deal with sleep deprivation!

In my future career as a nurse, I would like to continue to be part of the Irish Pilgrimage Trust, and return to Lourdes, just as those volunteers that I met and worked with have done for year after year. I believe that these experiences will help me to become a better nurse. As nursing students, we are taught of the importance to continually increase our knowledge. I believe that the role as a volunteer with the pilgrimage trust to be one of the best teachers.

108 Health Matters

Your Stories

Me and My Job End of Life Co-ordinator Bernadette O’Sullivan explains how end of life projects at Connolly Hospital, Blanchardstown, are making a difference.

Social Work Department. Additionally, the horticultural department of the Institute of Technology Blanchardstown (ITB) is providing high level expertise and knowledge to develop an adjoining bespoke garden facility.

Design and dignity in Connolly Hospital is promoted by the use of end of life resources, and the IHF/HSE have funded these resources to ensure availability. Small things make such an enormous difference to the hospital care provided. The use of the end of life symbol, drapes, ward altars and property handover bags help to ensure that the experience is more reverent and respectful for patients and their relatives.

+ Bernadette O’Sullivan, End of Life Co-ordinator.

S

ince 2002, I have been involved in the education and support of student nurses in Connolly Hospital, in my role as clinical placement co-ordinator. In 2008 an end of life initiative was commenced by the Irish Hospice Foundation (IHF) and the HSE. Its aim was to implement the principles of hospice care into acute clinical practice.

In 2012, I began working in the role of end of life co-ordinator in a part time capacity (one day a week) to support an ethos of excellence in end of life care. My role is multi-faceted. I am involved in the organisation and facilitation of design and dignity end of life care projects, which aim to improve the physical environment for

patients and their families.The development of the Blanchard Family Room is one such project in Connolly Hospital. This project focuses on improving accommodation and facilities for families when their relative is seriously ill or at end of life.

End of care projects Connolly is currently developing a family counselling and bereavement room. This room is being jointly funded by the IHF and HSE. It aims to provide an area to which service users/patients can escape from the hectic ward environment for counselling or just 'time out'. Counselling for family members will also be provided here by the

Education The organisation and facilitation of 'Final Journeys' education is an additional responsibility of my role, and this is supported by other educationalists. The education programme aims to improve communication skills and to develop a culture of awareness around end of life care. I plan and deliver this programme in conjunction with a motivated facilitators team.

In Connolly, there is an active End of Life Standing Committee. This committee meets every six weeks to review progress on the hospital action plan and to ensure the fulfilment of obligations as a hospicefriendly acute hospital. There is proactive and energetic service user representation on the committee.

Each week it is a challenge for me to fulfil two completely different roles. It is, however, heartening to view the improvements being made in end of life care. Connolly Hospital continues to receive positive end of life care reviews and words of thanks from relatives and patients.

Regardless of roles, each hospital staff member cares for or interacts with patients who are at end of life. Staff get just one opportunity to make this experience as dignified as possible for all those involved, but especially the patient. We, as health care professionals, can never lose sight of our potential impact on others.

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SUNRISE HORIZONS c o - o p er at i v e housin g f or e l d er l y p eo p l e When you get older, living alone can become daunting.

Fear of break-ins, lessened ability to prepare meals and do household tasks, as well as the problem of loneliness, are real issues for elderly people and for their family members.

Sunrise Horizons has a novel solution to the problem of living alone – with an Elderly Co-operative. The first house is planned for six people, ten minutes from Dungarvan on the Clonmel Road. Our aim is to enable elderly people to live out their autumn years independently yet in the company of others. Couples are also welcome.

Residents must be mobile, and capable of living independently. They will prepare their own breakfast and supper of their choice, with the shopping done for them. The main meal at lunchtime will be supplied, delivered piping hot from local restaurants. A lady will

call to the house once a day should anything be needed from the town.

The house has two sitting rooms and a conservatory, and a huge back garden to share. Privacy is also of the utmost importance and will always be respected. If a resident is not happy after any period of time, they are free to leave with no penalties imposed.

Residents are free to do as they wish and if they have a car can come and go as they please. They best comfort of all is the comfort of security, and Michael or his partner at Sunrise Horizons will always be available day or night at the end of the phone if any resident has any worries.

All this is for just €250 per week – considerably less than nursing homes that can charge more then €1,000 per week.

For more information on the elderly co-operative please call Michael on 087 9271459 or email sunrisehorizons@gmail.com

110 Health Matters

Occupational Therapy

Great Irish Bake Off For Bridget Harney, cooking and occupational therapy have always been synonymous – particularly in the area of mental health, writes Sarah Murphy.

L

ittle did Bridget Harney think that she would go from complete public anonymity to being a participant on TV3’s Great Irish Bake Off, when family members and friends encouraged her to apply to take part in the programme.

“Kitchen skills are an important aspect of a person’s independence, but also provide a forum to work on many skills, abilities, experience enjoyment and success,” explains Bridget.

“I have run baking groups in a few of my jobs, but the emphasis would always be on the participants developing skills themselves, not on me giving some kind of demonstration!

I currently run a kitchen skills group in Ballyfermot Day Hospital, and I think many of the people who participate in that might be surprised to learn that I am so interested in cooking, as allowing people to make mistakes is an important part of learning.”

Bridget trained as an occupational therapist in the University of Exeter and Plymouth and currently works in Ballyfermot Community Mental Health Team.

“The team here have strong roots in food, and have been very supportive when it comes to my baking practice,” she says.

Her interest in baking and cooking really stemmed from an enjoyment of food and growing up on a farm. Bridget never did any formal courses: “Much of my early experiences with cooking came courtesy of Maura Laverty’s Full and Plenty. Using recipes from a book published in the 1960s gave me a good foundation, but also a rather skewed image on how much butter and cream is actually healthy! I always try to promote healthy eating in my work, but also think the expression ‘a little bit of what you fancy does you good’ rings true.”

Bridget ended up participating in the Great Irish Bake off somewhat by accident.

“Friends and family encouraged me to apply, but I never thought it would result in me competing in the actual show. I am so grateful that I did.

“Competing in the show was a wonderfully interesting, terrifying and enjoyable

+ Bridget Harney.

experience! Working with the other bakers and everyone involved in the production was a lot of fun. Completing the actual challenges was incredibly challenging and stressful! The challenges really pushed you to try things and make things that you might not normally attempt. Baking in that environment is so different to what you do at home, and I will never again criticise what I see amateur bakers do in competitions on TV!” The OT goes quiet about how she does in the programme when asked, but there

is no doubt she will do well: her hazelnut shortbread is simply delicious.

Bridget admits that thinking about the future after the show is difficult. “I still can’t quite believe that I did the show!” she says. “I can’t imagine not working as an occupational therapist, but I do hope that the show may create other opportunities for me in my other passion, baking. Whatever does come of the show, I had a fantastic experience, met wonderful people, learnt a lot about baking and made some great friends.”

Health Matters 111

Occupational Therapy

Hazelnut Shortbread Sandwiches With a Chocolate Filling This recipe by Bridget Harney makes approximately 30 ‘digestive biscuit’-size single biscuits.

T

his is a recipe that you can try as a total beginner or as something a bit special if you already like to bake. The biscuits can be made to be eaten as they are, or sandwiched with the recipe here for chocolate ganache or a shop-bought chocolate hazelnut spread.

Shortbread ingredients • 350g plain flour • Pinch of salt • 225g unsalted butter • 2 teaspoons vanilla extract • 110g caster sugar • 75g chopped roasted hazelnuts (you can buy them prepared this way or do it yourself) Making the dough 1. Mix the salt and flour.

2. Use a knife to cut the butter into small pieces. It is easiest to do this in the flour so that the flour prevents the butter cubes from sticking together.

Then rubbing your fingers and thumbs together, mix the flour with the butter.

The end product will look like damp sand or breadcrumbs (you can also whizz it all up in a food processor if you prefer!).

3. Stir in the sugar, vanilla extract and hazelnuts.

4. Use your hands to crush together the mix to form a dough. You may need a couple of tablespoons of cold water to help with this.

3. Roll out between two pieces of greaseproof paper to about 2-3cm thick.

4. Take off the top piece of greaseproof paper and cut out biscuits using cutters, a glass or egg cup, depending on what size and shape you like. You can also roll out on a floured work surface if you prefer.

5. Pull away the dough from between the cut out shapes and use a knife to transfer the biscuits to an unlined, ungreased baking tray. Re-roll the remaining dough again and continue to cut out shapes. Sprinkle with caster sugar if you do not intend to fill them.

6. Bake for eight to 12 minutes. They should have a matt finish, be slightly firmer and slightly darker around the edges when baked.

•2 50g dark chocolate (between 60 and 80 per cent cocoa solids) •1 tablespoon of brown sugar (optional) •P inch of cinnamon (optional) •1 -2 tablespoons dark rum, cherry brandy or frangelico (optional) •2 5g chopped roasted hazelnuts (optional) 1. Break the chocolate into pieces and place in a heat proof bowl.

2. Heat the cream and brown sugar (if using) in a saucepan until bubbling around the edges.

3. Pour over the chocolate, submerging all the chocolate in the cream.

4. Leave to sit for four to five minutes and then slowly stir the mixture until smooth.

5. Add the cinnamon and liqueur, if using.

7. Leave to cool for five minutes, as they still will be very soft out of the oven. Use a knife to lift onto a plate or cooling rack to cool.

8. Enjoy as they are, or sandwich together as per the instructions below.

Shaping and baking the dough for cut out biscuits 1. Chill the dough in the fridge for 30 minutes.

Fillings: Chocolate filling • Chocolate hazelnut spread – use straight from the jar!

2. Preheat oven to 170ºC/Gas Mark 3/ 340ºF.

Chocolate ganache • 250ml cream

6. Allow to cool down for before placing in the fridge for 30 minutes to cool down and firm up.

7. Pipe (using a star-shaped nozzle) or use a knife to spread the mix (or chocolate hazelnut spread) on the underside of a cooled biscuit, and then sandwich another biscuit on top.

8. Dip the edges of the biscuit in the chopped nuts.

9. Enjoy with a hot beverage of your choice!

112 Health Matters

Your Stories

Me and

MY JOB

Dr Valleri Switzer is a senior clinical psychologist working in the Department of Liaison Psychiatry at University Hospital Limerick (UHL), Dooradoyle.

HOW LONG HAVE YOU WORKED AS A HSE PSYCHOLOGIST? I qualified as a clinical psychologist in 2001 and worked with the Irish Prison Service before joining the HSE to work in the Community Adult Mental Health Service in west Clare. In 2009 I took up a senior clinical psychology post in the Department of Liaison Psychiatry at UHL. This was the first clinical psychology post to be established in UHL and represented a broadening of the liaison team to include the discipline of psychology.

DESCRIBE THE WORK YOU DO? The main focus of my clinical work is on the psychological aspects of illness, injury and disease. When someone is diagnosed with a serious illness or disease, or has been seriously injured, there are a range of emotional responses that they can experience such as strong feelings of fear, worry, sadness, guilt or anger. These emotions are very much a normal response to this abnormal event in their life.

I see patients for psychological therapy in order to help them cope with what has happened to them, with the changes this event has brought into their lives and with the distress they are feeling. I work with clients on an individual basis as well as in groups. Educating both staff and patients on what to expect and how to cope when a person becomes seriously ill or suffers a serious injury represents an important part of my role.

HOW DO YOU HELP PEOPLE COPE? Psychological assessment represents an important first step in determining the most appropriate therapy. In my role in liaison I can provide short-to-medium psychological therapy.

Much of the work I do falls within a cognitivebehavioural therapy (CBT) framework. In CBT the focus is on the person’s thoughts, feelings and behaviours as well as how they experience distress in their body. I incorporate mindfulness practice into much of the therapy I do, as it has been shown to strengthen coping and build resilience over the longer term by giving us ways to tolerate difficult emotions in times of stress. Where the psychological assessment reveals that a person’s needs cannot be met by what I provide, I refer them to the more appropriate service outside of the hospital.

DO YOU HAVE A ROLE IN RELATION TO SUPPORTING STAFF IN THEIR WORK? Part of my role is to support staff in working psychologically with patients, however, last year I was invited to speak to staff on how to take care of themselves in doing the job they do. Due to the level of interest shown I ran a Stress Control course for staff earlier this year. Stress Control is a six-session taught programme typically delivered to the general public in a primary care setting. It was devised by clinical psychologist Dr Jim White in Glasgow to help the large number of people who complained of stress and who were keen to learn how to tackle their problems themselves. In response to the positive feedback received, Stress Control will run again for staff in February 2014.

WHAT IS THE BEST THING ABOUT YOUR JOB? Seeing how people’s resilience emerges in dealing with very difficult events in their lives

is one of the privileges of doing this kind of work. Another ‘best thing’ is the variety of the job, ranging from one-to-one psychotherapy with patients to group work to teaching/ training on education programmes.

WHAT IS THE HARDEST THING ABOUT YOUR JOB? As I have become more established in liaison, more and more demands are coming from across the hospital. As the only full-time designated clinical psychologist (for now), I am limited in how I can respond to those demands.

“Seeing how people’s resilience emerges in dealing with very difficult events in their lives is one of the privileges of doing this kind of work. ”

Health Matters 113

Art and Health

Good Healthcare a Work of Art Artists and healthcare professionals recently joined together in the north west to participate in a year-long professional development programme designed to assist them in their work with children and young people.

T

he programme, called Reflect Lab, was originally devised and delivered

by The Sage Gateshead, an arts initiative supported by the Arts Council in England and Gateshead Council.

Some 11 artists and 11 healthcare workers from Sligo and Donegal participated in the co-mentoring programme which was led by Helium, a company supported by the Arts Council in Ireland.

Helium is an arts and health organisation fostering a culture of creativity within Irish healthcare for children and young people, through the development of participatory arts programmes in community, primary, and acute healthcare environments. Their mission is to create positive experiences of hospital and healthcare settings for young people, to support a child-centred model of healthcare through the arts, and to innovate models of arts practice which give a creative voice to young people living with illness.

Art forms include circus, dance, literature, music, puppetry, theatre, traditional arts and visual arts. Since Helium was founded in 2009, over 3,000 young people and their families have participated in their programmes.

Reflect Lab Reflect Lab provided a unique opportunity to develop cross-sectoral professional learning, to build shared understanding of arts and health contexts and to connect the skills and vision of two diverse sectors in benefiting artistic practice and the quality of the healthcare context for children.

The programme was led by Helium under the Arts Council of Ireland Local Partnership Scheme and supported by Sligo County Council Arts Service, Donegal County Council Arts Office, HSE West (Sligo, Leitrim, and Donegal), Letterkenny General Hospital and Sligo General Hospital.

Reflect Lab trainers from The Sage

Gateshead facilitated the Irish cohort and provided mentoring to support Helium's management role in the process.

The aim of the Irish Reflect Lab was to advance arts and health partnerships in the provision of services for children and young people in healthcare settings in the north west. The programme was a collaborative learning process for people working across a range of sectors and offered participants the space and time to reflect on what they do and why they do it. Participants were given the opportunity to think creatively and to reappraise their professional practice from a new perspective.

A train the trainer programme ran alongside the main co-mentoring programme so that Irish arts organisations could learn the skills required to implement future co-mentoring projects.

was reinforced for the healthcare professionals together with a realisation of how they currently use the arts in their work. One healthcare professional commented that “it’s about remembering what we already do that is art within practice” while another had gained a better understanding of the “role arts has in health of children”.

The programme enhanced the network for artists and healthcare professionals, which impacts on the HSE as an organisation regarding increased awareness of arts and health leading to new creative perspectives.

A number of Reflect Lab activities have been planned beyond the pilot programme which was evaluated by Teresa Cawley, HSE West Regional Training and Development Officer (Child Health).

Network The need for arts and health programmes

More information is available on www.artsandhealth.ie and www.helium.ie.

+ The Wonder Web, created by an artist and the young clients of Creag Aran School, Naas, Co Kildare.

114 Health Matters

Life Stories

If You Were In My Shoes Now A recent community arts project at Naas General Hospital celebrated intergenerational creativity – and uniquely, the focal point was footwear.

N

aas General Hospital in County Kildare recently hosted a powerful exhibition entitled If You Were in My Shoes Now. The project was the culmination of a year-long intergenerational community participatory arts project that celebrates the creativity of the 50 participants.

It was lead by Creative Director Tony Fegan, artists Katrina Hughes, Gabriella McGrath and Kate Connaughton and writer Ann Egan.

The participants included the Nas na Riogh Housing Association, Kildare Youth Service, Kildare Carers' Association, Ballycane Primary School, Pipers Hill Community College, Naas Active Retirement, the National Learning Network and the Naas Child and Family.

It has been said that the choice of a pair of shoes tells a lot about a person and the show captures this entirely. The exhibition of bespoke customised felt slippers is accompanied by the participants' own story. They describe their memory of getting their first pair of shoes and how life in their shoes is today.

The display proved to be a powerful medium which captured the experience and wisdom gained in the participants' life times. Tony Fegan said: “This exhibition is a celebration of each individual’s creativity, but also the capacity of people to come together and work together and make something which they can all be collectively very proud of.

“We approached this project with the intention of creating an idea, a community of interest, through the making of art. We wanted to explore what the social glue consists of when people are being creative together. The series of relationships that have grown between the participants have come out of them making something together,“ he said.

Kathleen Higgins and her husband Andy were delighted to take part in the project

+ Bernadette Jackson, Naas Hospital, with exhibition participants Kathleen Higgins, Tom Foley, Andy Higgins, Niamh McCartan, Tony Fegan and Maeve Jordan, Dietetics Manager.

together. In her story, Kathleen shares the memory of getting her first pair of shoes – a pair of black laced shoes she got when she was four. “I felt so tall. It was brilliant. They got too small for me and were given to my younger sister. So the shoes were passed down ‘til they were worn down.”

Andy Higgins shares the story of the ‘Sunday best’ shoes he had when he was six years old. “When I put my feet into these shoes I felt like the best dressed person in Naas,” he said.

Wistfully, he remarks that “these shoes marked a time of great joy in my life”. At 16 Andy sat his post office exam, which he passed. The new job saw him cycle 26 miles per day, six days a week, in his shoes.

Tom Foley tells a story about his first pair of boots: jodhpur boots, tan in colour, “the

most comfortable boots I ever had”. The boots “took me to the USA on the second Freddy Laker flight from Gatwick. After one week working on the buildings in New Orleans, the boots died”.

Niamh McCartan remembers the shoes she had specially made because she had problems with a bunion. “My beloved husband thought it would be lovely to have a pair of shoes specially made for me. No, they weren’t stylish; they weren’t what I normally would have expected from a new pair of shoes. My husband had a great sense of humour.”

Naas General Hospital was chosen as a location to host the exhibition because of its accessibility to the community and the volume of patients, visitors and staff who pass through the reception area on a daily basis.

Health Matters 115

Immunisation

Get Protected – Get Your Flu Jab A simple vaccine can stave off the miseries of a flu – and it's particularly important for healthcare workers in order to prevent the spread of flu.

T

he flu season is almost upon us. For most, the flu is a horrible experience.

It can cause untold misery with up to ten days of fever, headaches and muscle pain.

However, we recover.

Unfortunately, some people are at risk of complications of the flu. These include people aged 65 and over, those ill with other conditions such as chronic heart or lung disease or diabetes, and pregnant women. For them, flu can cause devastating illness or even death. As healthcare workers we have a responsibility to those who we care for, so let’s not get or give the flu this year.

Seasonal flu vaccines have been safely providing protection from flu to millions of people around the world for over 60 years. Any side effects are usually mild and serious side effects are extremely rare. The flu vaccine cannot give you the flu, as it does not contain any live flu virus.

Seasonal flu vaccine is the only protection against the flu and people in the risk groups, along with all healthcare workers and carers who look after the ill and the elderly, need to get the vaccine every year.

The flu vaccine is free to healthcare workers to protect them from getting the flu and to prevent the spread of flu to family and patients. The last thing healthcare workers want to do, whether working in a hospital or in the community, is to put patients or loved ones at risk.

Healthcare workers should contact their line manager or occupational health department to arrange for vaccination.

The HSE’s dedicated immunisation website – www.immunisation.ie – provides details on the seasonal flu vaccine along with answers to any questions people may have about flu. Information leaflets are available for downloading and are also available in GP surgeries, pharmacies and HSE local health offices. Information is also available from the

HSE Infoline on 1850 24 1850.

A ten second flu shot is far better than

ten days of misery – or worse, serious complications of flu.

car & home insurance now even easier with AXA EasiPay EasiPay allows many health care employees to pay their motor and home insurance premium directly from their salary over 10 months at no extra cost.

What’s more, employees on the Easipay scheme can get 10% off a new home insurance policy or €30 off your home renewal (€150 minimum premium applies).

You can also get up to 10% discount on your motor insurance and free 24 hour breakdown assistance (€317 minimum premium applies).

AXA customers can also save money on DIY, car accessories and lots more. Go to axaplus.ie for more information.

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

redefining

standards

Terms and conditions apply. Minimum premiums do not include 5% Government Levy. Discounts cannot be used with other offers. For your own security and to help us improve our service, we may record or monitor phone calls. Free 24 hour breakdown cover is available to existing customers at next renewal. AXA Insurance Limited is regulated by the Central Bank of Ireland. 07/13 (3714 AD)

redefining Are you struggling to loose weight and keep it off Can’t face going on another diet?

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Interactive lifestyle education and behaviour change solutions, based on everyday foods, drinks and activities.

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There are nine key appointments over one year. *70% of those who attend the sessions weigh less at 12 months (Counterweight Project Team, 2012)

For further information on attending the programme or becoming a Counterweight Practitioner, contact Lorraine Cooney, Registered Dietician, BSc, MSc. T: 087 7733551

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standards

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Health Matters 117

Personal Finance

Increase Your Tax-free Lump Sum At Retirement The potential opportunity for employees to increase their tax-free lump sum at retirement is significant, writes Ivan Ahern, Director, Cornmarket Group Financial Services Ltd. f you are considering retiring before August 2014, the following will be of interest to you. One of the consequences of the recent changes affecting public sector employees has been the increase in the number of people who have retired in recent years, and this trend is likely to continue in light of the Haddington Road Agreement.

Without complicating matters, public sector employees at retirement receive a tax-free lump sum and pension. In general terms, when calculating these benefits, your employer has to take into account your pensionable salary and superannuated service along with any social welfare entitlements.

However, Revenue rules may differ to those applied by your employer when calculating your final pensionable salary.

One of the Revenue rules in relation to the calculation of your final pensionable salary allows individuals to receive benefits based on their earnings up to the five years preceding their retirement date.

This is of particular relevance to public sector employees who have experienced a reduction in salary in recent years and are retiring in the near future. In other words, this affects the vast majority of you!

Using a simple example of a public sector employee retiring on October 1st 2013 with 40 years’ service and a final pensionable salary of a54,426. Under superannuation rules, the employee will receive a tax-free lump sum of a81,639.

However, because the employee’s pensionable salary was a58,028 before the pay cuts in 2010 were implemented, Revenue rules now allow for a tax free lump sum of a92,047 to be paid – i.e. an extra a10,408.

In order to maximise this extra tax-free lump sum, it is necessary to invest in an AVC whereby you will benefit from tax relief

www.thinkstockphotos.com/istock

I

at your highest rate of tax. If you invested a10,408 into an AVC before you retire, at retirement you may be eligible for a tax rebate of up to a4,267 plus your a10,408 investment back, less any charges.

Again, all the above are general guidelines to what are complex rules.

The potential opportunity for employees to increase their tax-free lump sum is significant, especially taking into account the reductions in pay employees have suffered in recent years. It is important to seek advice on individual entitlements from an AVC provider, details of which are available from your pension/ superannuation officer or by visiting your union website.

“The potential opportunity for employees to increase their tax-free lump sum is significant, especially taking into account the reductions in pay employees have suffered in recent years.”

118 Health Matters

Emergency Services

Con survives cardiac arrest thanks to emergency services Local people who carried out CPR, the National Ambulance Service, a GP and the Intensive Care Unit at Cork University Hospital all played their part in helping Corkman Con O’Donovan to survive a heart attack earlier this year. Norma Deasy tells the story.

C

on O’Donovan (38) from Boherbue in north Cork is eagerly awaiting the impending arrival of his third child – while being fully aware that if it were not for the swift intervention of the HSE’s emergency services, he might not be in such a happy position.

One evening last April Con was feeling good and went for a game of soccer with his local team at Banteer’s indoor soccer pitch. According to Con, “I had no symptoms whatsoever and felt fine. I hadn’t a pain nor an ache when about ten minutes into the game apparently I suddenly collapsed. I was unconscious and have no memory of the whole event. I had been diagnosed with an aortic valve stenosis in 1995, which was being closely monitored, but I had no symptoms prior to the events last April.”

Advanced Paramedic Paul O’Driscoll, a staff member of the National Ambulance Service based in North Cork, describes how he received a call to rush to Banteer indoor pitch to assist a person who collapsed. Paul was on the scene within minutes. “On arrival in Banteer, I observed our Kanturk paramedic ambulance crew and some local lay people performing CPR (cardiac pulmonary resuscitation) on a young man. The crew handed his care over to me and following a quick assessment of the patient it was apparent that he was in cardiac arrest. One of the locals who had attended to assist with the CPR was Sheila Foley, a theatre nurse based at Mallow General Hospital.

“My paramedic colleagues Pat Larkin and Liam Healy continued CPR and defibrillated the patient while Sheila assisted me to perform an endotracheal intubation to secure the patient’s airway. Sheila also ventilated the patient, while I obtained an intraosseous access route (via the

+ L-R: The team who treated Con O’Donovan after he suffered a cardiac arrest while playing soccer in Banteer. L-R: Paramedics Pat Larkin and Paddy Moore; David Willis, Quality, Safety and Risk Manager; Paul O’Driscoll, Advanced Paramedic; Sheila Foley, nurse; Con O’Donovan; Liam Healy, paramedic and Dr Zelie Gaffney, GP, Newmarket.

patient’s shin bone) in order to administer appropriate medication.

“Paramedic Paddy Moore arrived on scene from Millstreet, as did Dr Zelie Gaffney, a GP based in Newmarket. Dr Gaffney immediately reviewed the patient’s condition while Paddy took on the role of documenting the resuscitation and crosschecking the medication. We performed advanced life support resuscitation for 35 minutes before there was a return of spontaneous circulation (ROSC), during which the patient was defibrillated nine times and administered cardiac drugs.”

A Positive Outcome While all of this is a day’s work for the emergency services, the staff are always aware of the patient’s vulnerability and do everything in their power to ensure a positive outcome, as was the case for Con. Paul continued to keep a watch on Con’s

condition while he remained in the Intensive Care Unit at Cork University Hospital, as he was very aware that this was a man with a young family. Although Con did go through a very slow and difficult recovery period, he pulled through in the end.

Con says he “will remain forever grateful to the interventions of all those on the evening in question. I am fully aware of the enormous efforts put in by all in attendance, particularly Paul O’Driscoll, Pat Larkin, Liam Healy, Paddy Moore, Kevin Roche, Sheila Foley and Dr Gaffney."

According to Dr Cathal O'Donnell, Medical Director of the National Ambulance Service: "This is a good example of all the links in the chain of survival working to save a life – local people in the community knowing how to do CPR, rapid response from the National Ambulance Service, and high quality medical care provided by advanced paramedics, paramedics and Dr Gaffney."

Health Matters 119

Sporting Passions

Tough rugby: great exercise, great fun Grainne Leach, who works with the HSE’s Primary Care Reimbursement Service in Dublin, is an enthusiastic advocate for touch rugby. She explains why the sport is such great fun and growing in popularity.

P

eople of all ages and fitness levels play touch rugby in social and competitive leagues here in Ireland. Touch is a game of extremely high skill levels and intensity and it is very strategic. It’s a great way to exercise, improve cardio-vascular fitness and helps to burn up excess fat.

This is a unique sport where men and women of any age can play side-byside and at international level. People of all ages and all fitness levels play touch throughout Ireland all year long. It’s a minimal contact sport and the emphasis is on running, agility, passing, catching and communication.

Touch is often referred to as touch rugby, but there are no tackling, line outs, scrummaging or kicking involved. This makes it appealing to a wide range of ages and abilities, from juniors to masters and from slight to heavy builds.

I started playing touch after I was involved in a road traffic accident in which I had my right arm amputated. I love the game because great people are involved who are very encouraging, and it’s also great fun. If you are interested I would encourage you to get involved.

+ Touch Rugby. Photo: Oliver O'Flanagan, ITA.

A Growing Sport Touch is a growing sport in Ireland, with increasing numbers taking up the game on a weekly basis. The Ireland Touch Association (ITA) is the national body responsible for the development of the sport of touch across the country. The ITA supports and co-ordinates leagues and competitions at all levels, and organises the national squads to participate at world and European level.

Touch has some similarities to rugby league and tag, but is very much a separate sport in its own right. The ITA is a full member of the Federation of International Touch (FIT).

If you are interested in taking up the game you can contact me through the Ireland Touch Association. I can provide you with contact details of where leagues are taking place. If there is no touch currently in your area, the ITA will offer advice on how to set up a team, some simple-to-follow grids and drills for skill development, and details of one-day or weekend tournaments in which you can compete. To start a team all you need is a ball and a pitch to play on, so putting a team together and practising is relatively easy. The pitch can be marked out with cones or the markings can be used

+ Grainne Leach.

on the field of a different sport (half a rugby pitch, for example).

Touch is very simple to play. Two or three games will see you master the basic skills and the more you play the better you will become. As long as you are keen to get involved you will develop the skills to enjoy yourself on the field.

People of all shapes, sizes, ages and fitness levels play in social and competitive leagues and you can choose the level at which you wish to play. You'll find over the season that your personal fitness levels will increase.

Grainne Leach is press officer for the Ireland Touch Rugby Association. She managed the Irish men’s over 40s touch rugby team which competed at the World Cup in Edinburgh in June 2012 and in the European Championships in Treviso, Italy in September 2012. The Irish men’s over 40s team won a bronze medal at the European Championships. She can be contacted at grainne.leach1@hse.ie.

120 Health Matters

competitions

Bridge House Hotel W

ith thanks to the Bridge House Hotel in Tullamore, Co Offaly, you could win a relaxing break for two at the midlands’ best loved four-star hotel, complete with luxury spa, Michelin Guide-recommended restaurant, an Italian restaurant and The Palace Tullamore nightclub.

Two adults will enjoy two nights' B&B midweek with dinner in the hotel’s Italian restaurant Balcone Italiano on one evening, a spa treatment each in Spa & Beauty @

The Bridge House and full use of the hotel’s leisure club throughout your stay.

The Bridge House Hotel has great spa breaks available, including two nights' B&B, a dinner on one evening, a spa treatment and a session in the spa’s Relaxation Chambers from just a149 per person sharing midweek, or a189 per person sharing at weekends!

Located less than 90 minutes from Dublin, Galway and Limerick, the

renowned Bridge House Hotel has 70 luxurious guest rooms, many with jacuzzi and balconies. Renowned for good food, hospitality and service, the Bridge House Hotel makes the perfect choice for a relaxing short break!

For further information visit www.bridgehousehoteltullamore.ie or Lo-call 1850 312 312/(057) 932 5600.

The Bridge House Hotel – one of Ireland’s greatest four-star hotels.

To win this superb prize, answer this question:

In which county is the Bridge House Hotel located? a) Carlow b) Westmeath c) Offaly Send your answer to competition2@ashvillemediagroup.com with 'Bridge House' as the subject title. Closing date: October 31st.

Hotel Kilkenny T

he chic four-star Hotel Kilkenny offers all the comforts of modernity while maintaining a rich connection to Kilkenny’s heritage. It is conveniently situated on the city’s Ring Road for ease of access, yet it’s only a short stroll away from the vibrant heart of Kilkenny where the magnificent Kilkenny Castle and Gardens await your exploration, as well as all the pleasures of this historic and welcoming city.

Hotel Kilkenny boasts a fantastic Leisure Centre with 20m pool, Jacuzzi, steam room and sauna – perfect for relaxing after a hectic day or night in the city. Its fantastic Kids’ Club is open every day from 9.30am to 12.30pm and 5.00pm to 10.00pm daily during the school break – and it’s fully supervised.

The Hotel Kilkenny is offering one lucky reader two nights’ accommodation and one evening meal for two people.

To be in with a chance of winning this fantastic prize, simply answer the following question:

On which river is Kilkenny located? a) Barrow b) Nore c) Suir Send your answer to competition2@ashvillemediagroup.com with 'Hotel Kilkenny' as the subject title. Closing date: October 31st.

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