HSE Health Matters Winter Issue 2020

MAT T ERS

Health S TA F F M AG A Z I N E O F T H E I R I S H H E A LT H S E R V I C E

WINTER 2020

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A M ESSAG E F RO M O UR ED I TO R Welcome to the latest edition of the new-look Health Matters.

After a year like no other, we again pay tribute to the tireless work and innovation that is going on throughout the health service in response to the COVID-19 pandemic.

Like so many healthcare facilities around the country, Cavan and Monaghan hospitals were blown away by the gestures of goodwill given to them from the local community since March: from the donations of PPE from local businesses and schools, the donations of meals and baked goods for staff, self-care packages for patients, the individuals who manufactured PPE, the ladies who crocheted hearts, the artists who volunteered their art for patient cards, the donations of tablets to allow patients communicate with their families, to the generous financial donations received from various fundraising initiatives for their frontline staff.

Those fundraising efforts will eventually see the construction of an outdoor eating space where staff can take a break from their work to enjoy some fresh air and quiet. It is hoped that is will be ready for staff by early spring. It will be a testament to the community spirit that has been fostered throughout the public health emergency.

For staff that find themselves struggling with the workload – both physical and mental - the Employment Assistance Programme is there to provide mental health supports, with counsellors available to listen.

One counsellor that we spoke to urged staff members to reach out for support, telling them that they are not on their own.

Ann Callanan, a counsellor with the programme since 2006, urged HSE staff struggling with the stresses brought on or exacerbated by the COVID-19 pandemic to get in contact.

She highlighted the value of speaking to a counsellor familiar with the unique pressures of working in the health service.

We also take a look at the Healthcare Work COVID-19 Helpline, another support in place for staff who can access vital information on any aspect of COVID-19 with just one phonecall.

A sincere thanks to all those who have sent in contributions to this edition and I hope you find plenty of interesting reading in it.

Happy Christmas and a healthy and safe new year to all our readers. Let’s hope 2021 brings us all some fresh hope and good news.

Joanne Weston Editor

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CONTENTS 01 CEO says thanks

44 Get Brexit ready

02 African museum artwork

45 Updates from Corporate Centre

46 Trauma strategy

Tribute to Francis Walsh

03 Cartoon visors

48 Adult safeguarding

04 Dementia activities

50 Finance reform

05 Alzheimer's month

51 Be GDPR aware

Whispering Hope choir

52 Allergy clinics

06 TUH heroes

53 Global health initiatives

Disabilities survey

54 State-of-the-art renal unit

ANP role

Kilmallock primary care centre

07 Room to improve

55 Age-friendly building

08 Green Fingers

56 Sligo-Leitrim mental health

10 COVID guidelines

58 Social prescribing

12 COVID contact tracing

59 Suicide prevention training

13 COVID tracker app

60 Robotic process automation#

14 Testing for children

61 Virtual orthopaedic clinic

15 EY award for HSE staff

16 Relocation relocation

62 Patient-centred service

18 Living Well education

programme

Robotic surgery COVID physio course

63 Managing waiting lists

20 Counselling support

22 Staff COVID helpline

64 Q connects

24 Appreciatioan day in Cavan

65 Make every contact count

25 Sandra gains confidence

66 Let's talk about consent

26 Flu vaccine for children

67 Sex education

27 HSE staff get the vaccine

69 Move to secondary school

29 Antenatal care goes online

33 Breastfeeding support

70 Screen time guidance

35 Diabetes in pregnancy app

71 Helen a star off the screen

36 Foetal alcohol syndrome

72 Quit smoking

37 New alcohol legislation

74 Healthy eating

38 Antibiotics misuse and overuse

75 Mind your wellbeing

40 Breast cancer screening

77 Knitting project

resumes

Nursing documentation

Trishaw introduced

78 Keeping well at home

42 Interval cancer reports

79 Steps to health

43 Frailty intervention team

80 Communicating with staff boost

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M EET T H E TEA M

A M E SSAG E F R O M O U R C EO PAU L R E I D H SE Head of Internal Communications Emma Finn Internal Communications Team Yvonne Costello Ann McLoone Jennifer Carrie Amy O'Neill

A s hvi l l e Medi a Grou p Editor Joanne Weston Art Director Áine Duffy Creative Director Jane Matthews Design Assistant Anna Wesolowska

Published by Ashville Media, Unit 55 Park West Road, Park West Industrial Estate, Dublin 12, D12 X9F9.

Tel: (01) 432 2200 ISSN: 0332-4400 All rights reserved. Every care has been taken to ensure that the information contained in this magazine is accurate. The publishers cannot, however, accept responsibility for errors or omissions. Reproduction by any means in whole or in part without the permission of the publisher is prohibited. © Ashville Media Group 2018.

As we reflect on what has been the most challenging and unprecedented year for everyone working in the delivery of healthcare nationally and internationally, I can only say one thing to our staff and to everyone who has worked so tirelessly in both the public and private sectors – thank you.

You will recall how the summer ‘Hold Firm’ edition of Health Matters reflected the many stories of innovation, dedication, courage and commitment shown by staff in every part of the country. Now, we prepare for a New Year and, significantly, new beginnings, new aspirations and renewed hope.

This has undoubtedly been a tough year for everyone. While Christmas 2020 may look and feel different, when we reflect back on the months of resilience, determination and hard work we should feel pride and should mark and celebrate that contribution both individually and collectively.

This year has been one of disruption, much sadness and loss for many families and one of change and challenge for all. It has also, however, been a year when the strength, bravery, commitment and innovation of the HSE was seen and valued in a new way.

We all adapted to new ways of working, new roles and new demands. We had to innovate and we had to assume new levels of autonomy. Expediency was often at the heart of all we did – in hospitals, in community services, in procurement, in support services. We may not have got everything right but we know that the speed of decision making this year was crucial.

Over the past few months we have hosted staff webinars which I hope you found useful and informative. During the most recent event, our Chief Operating Officer Anne O’Connor reflected back on the intensity with which we have all worked this year, especially in the first few months. She rightly

noted that amongst the challenges we all now face is maintenance of that momentum and ensuring we embed many of the new practices and innovations that were introduced this year. Such innovations will be pivotal for 2021.

The New Year will of course be challenging. We are still living with COVID-19 and striving to maintain our services whilst delivering a comprehensive Winter Plan.

We know we need to hold firm and do everything we can with our individual contributions. We have submitted an ambitious National Service Plan for 2021, reflecting the largest year-on-year increased investment the HSE has ever received. I look forward to working with each of you to bring it to fruition and deliver an improved health service for the people of Ireland.

Finally I want to share with you the special award I recently received on your behalf. On November 12th I attended the virtual EY Entrepreneur of the Year Gala Awards to receive the 2020 Special Award on behalf of frontline workers. Recognising the contribution of our frontline staff to the fight against COVID-19, the award was given to HSE staff for their outstanding service to the country.

In their citation the organisers noted how HSE staff had “represented the very best of us as we pulled together in 2020.”

I was humbled by the event but knew it was incredibly well deserved for all of our staff who gave so much this year and we particularly pay tribute to those healthcare workers who so sadly passed away. Our thoughts are with their families.

We should all look forward to 2021 knowing that while there are significant challenges ahead, we are contributing to the solutions that will help us all emerge from COVID-19 and our efforts are known, recognised and valued.

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Mairead Lehane, Advanced Nurse Practitioner and Patricia Moloney, Director of Nursing

MALLOW HOSPITAL APPOINTS FIRST ANP IN HEART FAILURE

HSE African Arts Museum presentation

AFRICAN MUSEUM Representatives of the African Museum presented an original piece of artwork to HSE CEO Paul Reid on behalf of all healthcare staff in tribute to their tireless hard work during the COVID-19 pandemic.

Titiloye Amzat, from the African Museum, explained that the work by artist Abolore Sobayo represents the sacrifice of the health workers in Ireland during the height of the virus.

“The painting has a face representing the resilient frontline worker with the Irish flag in the background. African motifs that represent hope and unity are embedded in the flag,” he said.

“At the peak of the pandemic, health workers were truly at the forefront confronting the challenges to protect all of us. We note with keen interest how people expressed love with gifts and applause to appreciate them. “On our part, we felt that an artwork could be a token of our appreciation to all the health workers in HSE because we are all concerned. The presentation was made to continue sending a message of appreciation even after COVID-19 has passed.”

Paul Reid thanked the African Museum for their very kind donation.

“It is an honour to accept this artwork on behalf of the HSE. We are so grateful for the continued support of our African community, especially the thousands who have formed a vital part of our frontline over the years, and continue to play a huge role in our fight against COVID,” said the HSE CEO.

Mairead Lehane has been appointed Mallow General Hospital’s first Advanced Nurse Practitioner (ANP).

Mairead, who has been working at MGH since 2001, will be based in the heart failure clinic and is the third ANP to be appointed to a heart failure post in Ireland.

Prior to her new role, Mairead completed her ANP training in MGH and Cork University Hospital (CUH), which involved 500 hours of supervised clinical practice. As an ANP working in the heart failure clinic, Mairead will work with the cardiology teams based in MGH and CUH to deliver a hub and spoke model of heart failure care. Patients will receive heart failure care in CUH (the Hub) and then access out-patient heart failure treatment locally in MGH (the Spoke).

Welcoming the new ANP to her post, Patricia Moloney, Director of Nursing, said, “Advanced Nurse Practitioners are highly experienced and autonomous practitioners. They use advanced specialist knowledge and critical thinking skills to independently provide optimum patient caseload management. Mairead has never accepted the status quo; always striving to positively and compassionately impact service delivery while working to the patient-centred ethos of a model two hospital. Using her leadership, knowledge translation and research skills, she will be a strong role model for the other clinical nurse specialists, nurse prescribers and nurses in MGH.”

FRANCIS WALSH TRIBUTE

Francis Walsh

HSE mental health services colleagues and friends have paid tribute to Francis Walsh, who sadly passed away very suddenly of a suspected aneurysm aged 48 years in May 2020. His family, friends and work colleagues have been left devastated over his untimely death.

Due to COVID-19 restrictions, a memorial has not been held yet for his colleagues to attend.

However people have comforted each other via phone call and online meetings. They hope

to hold a memorial for Francis in 2021 and also to publish a book of recovery narratives which will be dedicated to Francis. If you would like more information, please contact debbie. murphy5@hse.ie Francis worked in the HSE for over 25 years, first training as a psychiatric nurse in St Vincent’s hospital Fairview. He excelled as a nurse as he was hardworking, kind, compassionate and a real advocate for those

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CARTOON VISITORS Paediatric staff in Tallaght have turned their increased PPE into a reassuring ice-breaker for their young patients – thanks to some fun cartoon visors.

Many of the paediatric services in Children’s Health Ireland (CHI) at Tallaght saw a reduction in face-toface appointments during the height of the COVID-19 pandemic. It has been heartening for staff over recent months to see the increase in patient numbers again.

However, staff in healthcare settings are required to wear an increased amount of PPE in order to protect the patients and themselves. This is quite a change for regular patients to the hospital and might be a bit intimidating for them and also for new patients. This is particularly true in paediatrics.

Children with Cystic Fibrosis visit the hospital regularly. In order that they might be less intimidated by the PPE now being worn, the CF psychologist Helen Gibbons sourced a set of cartoon visors from a company in the UK. Jon Stynes Designs, based in

DAISY AWARD The Daisy Award went to the team in charge of the Newgrange 2 ward in Our Lady of Lourdes Hospital in Drogheda in October. It was an orthopaedic ward that became a COVID ward ‘with the nursing team responding without question or hesitation.

The Daisy Award is awarded to nursing teams who go above and beyond for their patients’.

he cared for. He was awarded student of the year whilst training.

Francis’s most recent role was as a national lead for Mental Health Engagement and Recovery. He was pivotal to the development of many recovery-oriented publications, trainings, policies and their implementation. Francis always ensured that the voice of the service user, their family and supporters and, indeed, service providers

Pictured from left to right (front to back) at a recent MDT CF meeting were: Prof Basil Elnazir, CF/respiratory consultant; Prof Peter Greally, CHI Chief Clinical Director; Ger Connell, CF CNS; Helen Gibbons, CF psychologist; Emma Kilbride, CF respiratory physiologist, Ger Leen, CF CNS, Dr Catherine Breen, CF registrar; Ruth Jennings, CF medical social worker; Jessica O’Driscoll, CF dietitian; Ciara Duffy, CF physiotherapist.

Cumbria, are making these cartoon visors for the NHS, nursery and infant schools, as well as other childcare settings. Helen spoke with Jon, the owner of the company, who told her that this was his first enquiry from Ireland and kindly offered to donate a set of visors to the CF team.

“We are very grateful for the donation as the cartoon visors have been a huge hit with the children and their families.

The visors are a great icebreaker and have certainly detracted from the anxiety

the children might have experienced,” said Helen.

“They are fun and make the children smile. They enjoy guessing what animal is being represented in the visor worn by each of the team. The visors have got many admiring glances and comments and you can see why!”

She said a big thank you to Tommy Walsh, Medical Photography, for attending a recent CF MDT Meeting and taking this photograph of the team in their cartoon visors.

BASIC LIFE SUPPORT TRAINING Kerry Mental Health Basic Life Support (BLS) instructors recommenced BLS under the new COVID-19 guidelines. Six participants attended the training and were instructed by CNS Cora Dennehy and CMHN Catherine Drinan.

BLS Coordinator in Kerry Mental Health is CPC Martina Fleming. Staff can now book a place for BLS through the CNME classroom management system.

Kerry Mental Health are delighted to be facilitated to train their staff in such fantastic facilities and would like to sincerely thank Anne Walsh, Director of Nursing, for the CNMEs Cork and Kerry.

were heard. Co-production was vital in any of the work Francis undertook. When you worked with Francis you were guaranteed two things: utmost dedication and a laugh to go with it.

“Frankie was a listener, advisor, confidant with a larger than life personality, full of life and humour. He was also a like life coach and career advisor.

Whenever you needed career advice of

which direction to go in, Frankie was the person to talk to,” said one colleague.

Another person who worked with him said, “Frankie was empathic and very tuned into the needs of his patients. He built up great relationships with the people he worked with and never failed to make everyone smile, whether they were the patient in the bed or the nurse on her seventh 12-hour shift of nights.”

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DEMENTIA ACTIVITIES

National Audit of Dementia Care in Acute Hospitals The HSE National Dementia Office launched the 2nd National Audit of Dementia Care in Acute Hospitals (INAD-2). The audit is extremely important in helping to improve the care of people living with dementia in acute hospitals. This audit shows promising improvements in the presence of dementia quality improvement teams and staff with a specific dementia role in many hospitals. There was also evidence of physical environment changes that would enhance the experience and safety of a person living with dementia.

Dementia Café Network Launched The Irish Dementia Café Network is a collaborative project commissioned by the National Dementia Office and established by Engaging Dementia.

The network includes 21 such cafés across 15 counties. Dementia Cafés are a welcoming, once monthly meeting for anyone who is living with dementia.

People with dementia, their families and friends, healthcare professionals, and people who are interested in supporting a dementia inclusive community, are all welcome to attend.

The official website for the Irish Dementia Café Network (www. dementiacafe.ie) was also launched. It is hoped that this will encourage other communities to set up a dementia café.

If you are interested in learning more about or setting up a café please contact cafenetwork@ engagingdementia.ie.

Young Onset Dementia (YOD) Review On World Alzheimer's Awareness Day, the National Dementia Office published Young Onset Dementia: A Review of Diagnostic and Post-diagnostic Processes and Pathways. The report brings together the most-up-to-date evidence on processes and pathways for people living with YOD. It was written by Dr Siobhan Fox, Rachel McGowan and Dr Caroline Kilty from University College Cork and Prof Suzanne Cahill from Trinity College Dublin and was commissioned as part

At the launch of the Boots dementia training for staff were: Martha Ryan, Head of HR, Boots Ireland; Joe Scallan, Head of Stores, Boots Ireland; and Fiona Foley, National Co-Ordinator, Dementia: Understand Together in Communities.

of the implementation of the National Dementia Strategy.

The findings highlight the current position of healthcare for people with YOD, an estimated 4,400 people. The report puts forward a number of recommendations to guide the development of policy and services to improve the quality of life for those living with YOD. You can read the full report here www.dementiapathways.ie Weekly Activity Planner The Weekly Activity Planner is a guide to establishing new routines with an option to develop your own weekly schedule also based on what has worked well for both the carer and the person with dementia. www.understandtogether.ie/ Training-resources/HelpfulResources/Publications/WeeklyActivity-Planner-for-people-withdementia-families-and-carers.pdf

Resource Hub The Resource hub is a collection of resources compiled by the National Dementia Office, Dementia Understand Together, ASI & DSiDC. The information in the resource hub is separated into three themes Medical, Practical and Emotional - and includes helplines and links to other helpful organisations.

If you have a trusted resource that has been helpful to you, do let us know by emailing dementia.office@hse.ie Link to resource hub - www. understandtogether.ie/Training-resources/ Helpful-Resources/Publications/COVID-19Online-Resource-Hub.pdf At Home Activities Booklet This information booklet was compiled by Emma O’Brien, Occupational Therapist at the Memory Technology Resource Room (MTRR). This guide provides a selection of meaningful activities for people with dementia, families and carers. www.understandtogether.ie/Trainingresources/Helpful-Resources/Publications/ At%20Home%20Activities.pdf

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WORLD ALZHEIMER'S MONTH Ahead of World Alzheimer’s Month, the Dementia: Understand Together campaign highlighted the new prevalence figures of dementia and latest county statistics.

More than 64,000 are living with dementia in Ireland and everyday 30 people develop dementia, the majority of whom are living in their communities.

With this is mind, the focus for World Alzheimer's Month was to continue the conversation around dementia and the role communities play in including and supporting people with dementia and their families. Recent months have been especially difficult, with many are missing out on social connections and activities so vital for wellbeing.

A four-part article series gave readers encouragement with a range of topics, from enjoying life in a time of COVID with advice for at-home activities written by Emma O’Brien, HSE Occupational Therapist. Eibhlis Cahalane, Project lead for the Memory Technology Resource Room (MTRR) Project, wrote a piece on dementia and technology, highlighting the service provided by local MTRRs and assistive technologies available to those living with memory difficulties.

Dr Suzanne Timmons, Consultant Geriatrician and Clinical Lead of the HSE’s National Dementia Office, shared the reasons why people with dementia can be hopeful for the future.

Encouraging every member of society to get involved in the national campaign and focusing on practical actions we can all take to support people living with dementia as we head into winter months was the theme of Fiona Foley’s article. Fiona is the National Coordinator of Dementia: Understand Together in Communities.

40 national organisations and 340 community champions have now joined Dementia: Understand Together and through their actions are changing the culture around dementia.

Boots Ireland announced the significant step they have undertaken in supporting people living with dementia in communities across Ireland by providing training to all staff that will promote a dementia-inclusive environment across its 89 retail and pharmacy outlets.

The Alzheimer Society provided an online activities week and hosted a monthly calendar highlighting all the events across the country.

Technology also plays a part in creating better understanding of dementia and so three new online trainings developed with campaign partners are going live to reach our communities.

• Dementia awareness • Inclusive Design • Azure programme Local community champions work with organisations, councils and local businesses to raise awareness of dementia, hold information talks, create inclusive services and inspire choirs, sports and other community groups to embrace people with dementia.

Find out more about how you can get involved at www.understandtogether.ie/get-involved/

News

WHISPERING HOPE ACROSS DUBLIN NORTH “We started the Rising Voices choir, a dementia friendly choir, in the HSE Odin’s Wood Day Care Centre in Finglas West in September 2019, to support people who are affected by memory loss, their carers, family and friends,” explained Paula Bermingham, HSE Odin’s Wood Day Centre Manager.

Rising Voices is a partnership between Dublin City Council, who fund the choir director, and Community Healthcare Organisation Dublin North City and County (CHO DNCC) who provide the premises, organisation, and Health Care Assistant support.

“Our first public performance was in the Mansion House in February 2020 for Cllr Dermot Lacey. It was such fun, and so many came along to make it work so well. It was a roaring success,” said Paula.

More than 40 people performed on the day. The performers were supported on stage by family carers and volunteers including a retired PHN from Wellmount Health Centre.

With the onset of COVID-19 the choir were disappointed they could not meet and this proved both challenging and stressful for those with dementia and their carers.

“In an act of camaraderie and resilience, we set up an online group where some choir members and family carers could meet for a weekly sing-along and chat,” she said, explaining that, “evidence shows music can boost mood, reduce agitation and improve focus for dementia patients, and we find this with our choir members continuing to engage in fun and friendship during the weekly call,” said Shona Rusk, Manager of Services for Older Persons, CHO Dublin North City and County.

Paula explained how they’ve performed during COVID-19 restrictions.

“We take a creative approach to opportunities as they arise.

The Rising Voices choir was invited to participate in Social Inclusion Week so our choir director Marion McEvoy put together some fireside sing-a-long videos which had been shared with choir members.

Marion chose ‘Whispering Hope’ as the piece the choir would perform and it was very powerful, the words of the song speak for themselves and are relevant in the current climate,” said Paula.

“We held socially distanced recording in Odin’s Wood Day Care Centre, in members’ own homes and Beneavin Manor Nursing Home. We are very grateful to the pianist Brian Ingoldsby for providing the music and to our choir director who edited and compiled the recordings into a first rate presentation.”

Membership is open to anyone affected by dementia and memory loss and is on an open non-committed basis. New members are always welcome.

To find out more please contact: Paula Bermingham, Odins Wood, 01-8142505

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SUPPORTING STAFF WITH DISABILITIES

The HSE is an equal opportunities employer and welcomes employees with a diverse range of backgrounds and abilities.

We value our employees' diversity because of each staff member’s unique contribution to our health services.

As one of the country’s largest employers, we want to support those of you who have disabilities or chronic conditions, when you start work or acquire disabilities later in your career.

The Disability Act (2005) states that we must ensure that at least 3% of our workforce are people with disabilities. This employment target will increase to 6% by 2024.

To determine the number of staff with disabilities in the HSE we have until now undertaken a number of different approaches, including most recently, the ‘Your Opinion Counts’ surveys.

The HSE has a strategy in place to make positive changes in a range of areas to help staff with disabilities to maximise their potential in work. The framework supporting this strategy involved setting up a Disability Technical Group. This framework also includes a Disability Action Plan to guide these developments over the coming years. Through this survey, we will gain information that will help to inform the group on how to direct resources and support our staff with disabilities in a more meaningful way.

POSITIVE IMPACT OF ANP ROLE

TUH HEROES Like so many things in 2020, Tallaght University Hospital (TUH) is celebrating their annual Hero Awards a little later than normal. The awards, now in their third year, recognise individuals and teams that make a special difference to patients and their families. Traditionally nine awards are presented but given the unprecedented year experienced by the hospital, a total of 10 awards were handed out, from Patient Experience to Unsung Hero and Team of the Year.

“The past few months have been extremely challenging at a professional and personal level. I am incredibly proud of both our staff and local community and how they have supported one another through these uncertain times. The year is not over yet and I have no doubt there will be further challenges for us to face but I thought it was incredibly important to take some time to acknowledge the incredible efforts of staff. The efforts that they go to embodying our ethos of people caring for people to live better lives each and every day,” said Lucy Nugent, chief executive of TUH. Director of HR Sharon Larkin, added, “Each and every member of staff make an incredible contribution every day and this year has been exceptional.”

The 2020 TUH Hero Award Categories and winners: Patient Experience – Professor Catherine Wall, Consultant Nephrologist and Director of Quality Safety & Risk Management; People Caring for People – Patricia Morrison, Assistant Director of Nursing, Perioperative Directorate; Unsung Hero – Ian Healy, Portering Service; Service Excellence – Pradeep Govender, Consultant Radiologist, Radiology Directorate; Mentoring Award – Sandra Hartigan, Emergency Department; Teamwork Award– Padraig Byrne Porter in Occupational Therapy Services; Team of the Year – COVID ICU Team; CEO Awards - Wendy Moynan, Social Work Department; Dr Ciara Martin, Paediatric Executive Lead for CHI at Tallaght; Professor Gerry Fitzpatrick.

The role of the Advanced Nurse Practitioner (ANP) has had a very positive impact for residents, their families and their nursing team in the residential care setting for older adults during the COVID-19 pandemic.

Mary Doyle, ANP, older person care, Peamount Healthcare, explained that the ANP role in the residential care setting during COVID-19 is providing clinical expertise, assessing and planning care and treatments in response to the changing care needs of the residents. It is also effective decision-making, and support for the nursing team, enhancing communication with residents and families including advanced care planning and end-oflife care.

"The role of the ANP in older person care role in the residential care setting during the pandemic has demonstrated positive outcomes for residents, their families and staff and should be considered in the future model of care for older adults in residential care in both the public and private sector," she said.

Mary paid tribute to residents and staff during the most difficult times of COVID-19.

“I have witnessed a celebration of our residents’ lives, support and sadness when a resident dies and staff trying desperately to offer comfort to grieving relatives while being denied the ability to touch.”

Mary Doyle, Advanced Nurse Practitioner, Older Person Care, Peamount Healthcare.

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Cancer Room

Room to ımprove A new dedicated paediatric oncology room has been unveiled in Our Lady of Lourdes Hospital in Drogheda to help make the medical appointments a little less daunting for the young cancer patients.

T

he room is thanks to the joint efforts of Drogheda Rotary Club and the Childhood Cancer Foundation.

One woman who knows all about how poor the conditions were is the senior paediatric oncology nurse Connie Crehan.

“The difference this will make is unbelievable, and we have wanted a room recognising the importance of the oncology service for children and young people now for decades, so it is amazing to have it now,” said Connie.

“Before, nobody knew where they were going – some days you would have to use an empty office to change dressings or clean the lines – and to have a child-friendly, non-clinical room now makes all the difference.”

Instead of cramped conditions the children faced before, they are now seen in a bright and colourful room, which is child-friendly and welcoming, as well as safe and hygienic.

The walls are decorated with cheerful murals and there is a huge range of games and toys to keep minds of all ages occupied and distracted.

Mary-Claire Rennick of the Childhood Cancer Foundation explained, “While the medical attention is always excellent, sometimes the facilities are poor. We try to liaise with the Shared

Former cancer patient Alice Turner and her mammy Lyndsey; Carl Allen of Drogheda Rotary Club; Mary Claire Rennick of Childhood Cancer Foundation Ireland; and Connie Crehan from Our Lady of Lourdes Hospital.

Photo: Paul Connor

Care hospitals around the country – of which the Lourdes is one – and when we asked the staff in Drogheda what they needed was a dedicated oncology room on the children’s ward where children with cancer could be treated with dignity and respect.”

Before this, when children were attending the Lourdes for checks and follow-up procedures outside Crumlin, they might have had to wait for hours until an empty room or space might come available.

“Before this, they might have to sit on the floor of the waiting room or be moved from room to room, or even be treated in the nurses’ station and that put so much pressure on the parents and children who were already under strain,” said Mary.

“Someone mentioned Drogheda Rotary Club to me and I was put in touch with the Rotary President Karl Allen, and they said they would be delighted to come on board.”

In fact the minute Karl and his fundraising committee heard about the project, the club offered to fund the entire cost of the room.

“As soon as the hospital found a suitable room, we said we would be delighted to pay for the cost of making it comfortable for the children. We donated the entire proceeds of last year’s Golf Classic, which raised over €11,000. It is an amazing cause, and none of us know when someone we know or love might need it,” said Karl.

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Innovation

GREEN FINGERS Gardening, carrots and rabbits all part of daily life for Navan Road Community Nursing Unit

N

ear the Phoenix Park in the north of Dublin city, tucked away off the main Navan Road, is a leafy quiet haven called the Navan Road Community Nursing Unit, which is home to a small community of older people, and features a vintage train station, with olden timetables.

Caroline Gourley, Interim Area Director of Nursing of Older People, explained the approach they’ve taken. “When family visit, we want them to feel at home and to connect with their loved one, they often sit in the train station we built, have a cup of coffee, and reminisce,” she said.

Caroline talked about the inspiration behind the approach. “The activity coordinators listened very closely to the people who live here, their stories and histories, and used it as inspiration to create things, like the train we built, for a bit of fun. We’ve a little village, with a shop front and a pretend post-box, and inside we’ve even

built a small community area and we get together every Friday and the residents really enjoy meeting up and socialising there as well as having a walk around the village.”

Green fingers are also clearly a feature of both the residents and the team who work there.

“We’ve a vegetable and flower garden, which not only feed our resident rabbit, but also are used when we’re preparing food.

There are squirrels living nearby who come to visit but thankfully we’ve not spotted any deer from the nearby Phoenix Park who would probably devour all of our delicious produce,” said Caroline.

Caroline and her team are all about involving those living in the nursing unit, with 39 beds.

“Our residents have a lot to give. This year we had a delicious crop of apples and tomatoes and carrots. Watching the vegetables and fruit grow, brings residents back to their days before they were in the

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Innovation WORLD PHYSIO DAY

Limerick City patient Joan MacCarthy is pictured with Conor O’Mahony, staff grade physiotherapist, and Caoimhe Gilmore, senior physiotherapist.

UL Hospitals Group physiotherapists mark World Physiotherapy Day

nursing unit, and gives them a sense of purpose. They see how much they are needed. Our residents have a lot to give, our team want to help them to feel back in themselves, it can be hard with residents who may not recognise things, but having the old tickets, timetables and a butchers and postoffice, brings back fond memories.”

These interesting and unusual memories are great conversations starters, Caroline added.

“The village sparks great chats, I remember one wonderful conversation about a woman who ran a sweet shop, where we talked about the various sweets and everyone’s childhood memories, buying a quarter of sweets.

Conversations like this are hugely positive for everyone.”

Caroline loves her role, saying, “I’ve been working here for four years, and I’m so proud of the team here, I’m very proud of them, the resident is always thought of first. This is one of four community nursing units across Dublin North City and County, we have so much creativity and care from everyone working here, I’m very glad to be working as part of this team.”

Speaking about the approach taken in the Community Nursing Units, Mellany McLoone, Chief Officer, said, “The team’s approach has ensured the comfort of residents. It also provides a warm, interesting, stimulating environment where they live, with the health supports they require. It really demonstrates the value of community healthcare.”

“WHEN FAMILY VISIT, WE WANT THEM TO FEEL AT HOME AND TO CONNECT WITH THEIR LOVED ONE, THEY OFTEN SIT IN THE TRAIN STATION WE BUILT, HAVE A CUP OF COFFEE, AND REMINISCE,” SHE SAID.

Physiotherapists at UL Hospitals Group marked World Physiotherapy Day with lunchtime exercise classes and information sessions highlighting how their work that came to the fore during the COVID-19 pandemic can enhance the health and wellbeing of all health service staff.

Media coverage of the pandemic has raised public understanding of physiotherapy beyond traditional misconceptions of a profession for treatment of sports and musculoskeletal injury, especially television footage that offered unprecedented insight into the role of physiotherapists in critical care settings.

However, Health and Social Care Professionals (HSCP) emphasise that this is only the beginning of the patient’s interaction with physiotherapy. Rehabilitation from COVID-19 involves ongoing input from physiotherapy, and physiotherapists in UL Hospitals Group are uniquely placed to demonstrate how this ongoing physiotherapy can benefit health service staff as well as patients.

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COVID

COVID GUIDELINES

At the onset of the pandemic, our frontline staff faced the immediate challenge of managing cases of COVID-19 across healthcare settings with little time to plan and prepare. What staff needed was fingertip access to a single source of readily available, up-to-date clinical guidance to support them.

To meet this need Clinical Design and Innovation (CDI), in partnership with HSE National Health Library & Knowledge Service and HSE Research & Development (R&D), launched the COVID-19 HSE Clinical Guidance and Evidence Repository. The Repository can be found at https://hse. drsteevenslibrary.ie/Covid19V2/home In a matter of weeks this repository was designed, built and populated with over 100 clinical guidance documents; a huge undertaking which demonstrates just what can be achieved when teams come together for a common cause.

For this to have been possible, a number of pieces needed to be pulled together in quick succession, with all three partners having a role to play.

The call went out from CDI to the National Clinical Programmes to develop clinical guidance specific to each of their areas of specialism.

HSE National Health Library & Knowledge Service provided the back-end system Libguides from which to build the repository. HSE R&D brought project management resources to get the Libguide up and running. CDI provided direction on the best layout to host the guidance and summaries of evidence on the repository and managed the governance process for information upload.

The HSE Library and R&D teams worked around the clock to upload the

initial bulk of the clinical guidance during the first peak of the pandemic.

Once the repository was up and running, summaries of evidence, aligned to and informing guidance were developed, along with additional clinical guidance, bringing the total number of guidance documents and associated supporting summaries of evidence now available on the site to over 230.

Interim Clinical Guidance documents are based on best available knowledge at the time of writing and are created by clinical subject matter experts (SMEs), within Guidance Development Groups.

In the seven months since going live the site has received 320,710 visits. The most viewed tabs are Medication, Point of Care Tools and Residential Services, with the most viewed summaries of evidence being Medication, Infection Prevention and Control and Mental Health.

The collaborative work accomplished in the establishment of the COVID-19 HSE Interim Clinical Guidance and Evidence Repository has demonstrated how the collective coming together of staff in support of the overall COVID-19 effort was really effective. Combining expertise from different HSE functions has facilitated the opportunity for national clinical programmes, acute services and the wider public health system to collaborate and respond to the pandemic and function in a coordinated way.

DID YOU KNOW

46% OF USERS VIEW THE LIBGUIDE ON MOBILE DEVICES

For further information on: COVID-19 HSE Clinical Guidance and Evidence Repository – contact barbara.riddell@hse.ie COVID-19 Evidence Service – contact brendan.leen@hse.ie

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COVID

BMJ BEST PRACTICE

What have p eop l e s ai d ab ou t t h e p ro g ra m m e?

"Thank you very much for this. We really appreciate the extensive work and information which is of significant value to us."

MICHAEL WALSH (National Clinical Programme Manager for dermatology and Disability)

"It has been very useful to our work on developing draft guidance for CCO office on in-hospital resuscitation in the context of COVID-19."

DR. MIRIAM BELL (National Deteriorating Patient Recognition and Response Improvement Programme)

"I had not anticipated such a comprehensive response and I can't thank you enough for saving the team hours of work looking for these references."

DR. ANNE JEFFERS (National Cinical Lead for the Clinical Programme for the Assessment and Management of Patients)

The HSE National Health Library & Knowledge Service, HSE Primary Care Division and the National Ambulance Service (NAS) have worked in partnership to provide nationwide access to the clinical decision support tool, BMJ Best Practice. All healthcare professionals and the general public can freely access it, and it is hoped that general practitioners and others working in primary care in particular will find it useful.Aoife Lawton, National HSE Librarian, said, “Working together with key partners in the HSE has meant that we have been able to deliver upon our HSE Service Plan commitment, to ensure that in 2020 all staff working in hospital and community settings have free online access to eHealth Library services. Having access to authoritative evidence-based information during COVID-19 is an essential part of a well-functioning health system and never has this access been more timely or more necessary.”Ranked one of the best clinical decision support tools for health professionals worldwide, BMJ Best Practice takes you quickly and accurately to the latest evidence-based information, whenever and wherever you need it. The step by step guidance on diagnosis, prognosis, treatment, and prevention is updated daily using robust evidence-based methodology and expert opinion.BMJ Best Practice includes 1000+ evidence-based condition and symptom topics across 32 clinical specialties which provides guidance throughout the full patient journey, from determining diagnosis and treatment approach to follow up support. It includes strong coverage of Covid-19 research and best practice, with patient documentation and a weekly podcast discussing the latest developments. In addition to these resources Covid-19 is covered as a speciality topic, allowing practitioners to zero in on the latest screening and prevention techniques.

What does it do?

BMJ Best Practice is intended to support healthcare workers at the point of care. It is organised into a series of specialties, from anaesthesiology to vascular surgery. With a dedicated app always enables access both offline and online, it is well suited for use in surgeries, consultation rooms – even busy hospital corridors. Along with topic overviews, BMJ Best Practice provides an extensive suite of assessment for a wide range of signs and symptoms, allowing for rapid on-the-spot diagnosis.

How do I access it?

BMJ Best Practice can be accessed from both its own website (https://bestpractice.bmj.com/) and the hselibrary.ie site.

It is also available as an app from Google Play and Apple’s App Store, once you have set up a personal account. If you have queries about accessing BMJ Best Practice, contact the National Health Library and Knowledge Service at hselibrary@hse.ie.

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COVID

PROGRAMME CONTINUES TO EVOLVE

A DAY IN THE LIFE OF A CONTACT TRACING CENTRE A Contact Tracing Centre (CTC) is where people who are employed as contact tracers are involved in making three different types of calls to people who test positive for COVID-19, and to the people who have been identified by them as their close contacts. Paddy Allen, Contact Management Programme Internal Communications, travelled to Galway CTC to find out what a typical day is like.

I arrived into Galway CTC just before 8am.

The day starts at 8am and finishes at 8pm with 15 contact tracers in the room at any one time working in shifts of four, eight or 12 hours duration. It was a pristinely clean place with multiple screens and individual headsets, which I was advised are taken home each day for cleaning. Desks are individual and strategically placed more than two metres apart. A master screen tracking progress and signposting changes in public health advice is visible to all at the head of the room.

Each space is dedicated to either administration or contact tracing. As 9am approached, I watched four people make four Call 1s. One contact tracer, Marcella Gemmell, is redeployed from the National Ambulance Service as a paramedic and highlighted the importance of remaining person-centred on each call. Marcella said that she treats every call as a chance to check in on someone and ensure they are alright.

Mary B Rice, the clinical lead on site, spoke of a challenging call, where a caller was talking to a person who was coughing blood and called Mary for help. She joined the call, phoned the ambulance and brought a sense of calm to the situation. Afterwards, she brought the distressed contact tracer for a walk and coffee and allowed them a chance to talk through what they had experienced.

During the day, through casual conversation with some of the contact tracers, I observed

that some people had been in the CTC in two separate stints. Michelle Tully is one – a Speech and Language Therapist (SLT) by profession, she volunteered to do some contact tracing on a part time basis between March and June. The reduction in cases during the summer saw Michelle return to her role as an SLT on a full time basis. Sure enough, when wave two struck at the end of August, Michelle returned to Galway CTC as a full-time contact tracer. She said that the level of training and co-ordination from management is great and she will be returning to her role as a SLT on a full-time basis again on November 16th.

The systematic flow from call to call, with confidence from contact tracers in Galway is a direct result of the calming influence from Mary Clare O’Hara, the Centre Mobiliser. She has been there from day 1 and told me of the challenges faced over the summer with staffing and trying to synchronise multiple premises across Galway and Mayo. She subsequently orchestrated the move into one central premises in Ballybrit, Galway and designed the plan for the winter months ahead to recruit a permanent team of contact tracers. On this day, the busiest person was Niamh Kelly, the shift lead. Niamh was tasked with overseeing and supporting 30 virtual contact tracers working from home as well as the 15 or so present. She really enjoys watching new recruits grow in knowledge and confidence on calls.

Upon sitting down to reflect on the generosity, warmth and enthusiasm I felt in Galway last week, it is clear that while technology, premises and planning can contribute towards the success of contact tracing, it is ultimately the people involved who have made it work up until now and I have no doubt, will continue to thrive in the coming months.

The HSE COVID-19 Contact Management Programme (CMP) was established in response to the coronavirus pandemic to support Public Health in managing the virus. The CMP is led by Dr Sarah Doyle and Mr Kilian McGrane. The programme continues to evolve in response to the virus. Mobilisation and operationalisation of Contact Tracing Centres (CTCs) commenced in March 2020 in various locations across Ireland.

The CMP is supported by Customer Relationship Management IT platform from Microsoft Dynamics called the CovidCare Tracker. The system is used by contact tracers when making calls.

Call 1 – this call is to confirm that the person has tested positive for COVID-19, it’s to check how the person is feeling, and it’s also to provide public health guidance.

Call 2 – usually about an hour later, involves capturing names and contact details of everyone who has been identified as a close contact by the person testing positive for COVID-19, from 48 hours before the onset of symptoms.

Call 3 – this call is to the close contacts of the person testing positive for COVID-19. The purpose of this call is to provide public health guidance. Essential to this call is referring the individual for a COVID-19 test close to their home. In certain circumstances where there is a clinical need, a home test can be facilitated. The person also receives a daily text message reminding them of key advice and the restricted movement period.

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NEW PROGRAMME As part of the HSE COVID-19 Contact Management Programme (CMP), the CMP Education and Resources Enabling Function with colleagues were tasked with designing and developing educational programmes and resources for Contact Tracing Centres (CTCs) and other contact tracing teams.

The CMP Education and Resources Development team are responsible for the design, development, co-production and continuous updating of education materials, programmes and resources to support contact tracers within CTCs and across other settings. Members of the CMP Education and Resource Enabling Function collaborated with RCSI and established a dedicated Moodle team to support the specific requirements of the CMP. In collaboration with the RCSI, members of the HSE/RCSI CMP Moodle Team designed and established a designated COVID-19 CMP Moodle site to host the education programmes, resources and material required for the CMP. This digital learning platform is available to access via the RCSI elearning portal for all registered users of the site (via personal log in

COVID

and password). The Moodle site went live on March 20th 2020 and, as at June 2020, there are 1,650 active users of the site (users include staff in all CTCs, Public Health Departments, Occupational Health, Irish Prison Service, and other HSE staff who required access to the site).

An agreed pathway was established, facilitated and coordinated by the HSE/RCSI Moodle Team for uploading resources and providing access to new users, with daily meetings to review operations and overall arrangements.

Quality Assurance checks were carried out on all material uploaded to the site and summary change lists were added to the “Recent Updates” folder on Moodle to alert all users to any changes and new additions to the site. A dedicated email address (hsemoodleaccess@hse.ie) was established to centralise the process of applications and access. In addition the RCSI provided helpdesk support (contact-tracingtraining@rcsi.ie) for Moodle users to troubleshoot any technical queries received and any additional queries were referred to the HSE (Moodle Team).

THE COVID TRACKER APP The COVID Tracker App currently has 1.32 million users and has sent close contact alerts to 8.2k people allowing them to restrict their movement quickly and get access to testing.

The latest release of the COVID Tracker App has a new feature which has been developed specifically for Health Care Workers. The new feature allows you to pause contact tracing for a period of time and sends you a reminder to switch it back on.

We encourage all health care workers and GPs to download and use the app, but there are some simple steps you will need to take to ensure that you do not receive close contact alerts when the risk of transmission is reduced or non-existent due to the use of PPE. USING THE APP DURING PATIENT CARE The latest release of the COVID Tracker App has a new feature which has been developed specifically for Health Care Workers. The new feature allows you to pause contact tracing for a period of time and sends you a reminder to switch it back on.

We recommend that if you are wearing appropriate PPE when providing care to patients that you use the pause feature. This will stop you receiving a close contact alert relating to contacts that happen while you are wearing PPE. When you want to pause contact tracing at the start of your shift, click on the contact tracing icon at the bottom of the app and select when you want to be reminded to switch contact tracing back on and then click on the Pause Contact Tracing button.

The phone will send you a notification to remind you to turn contact tracing back on If you are caring for patients while wearing PPE, the COVID Tracker app will not be able to distinguish that you are in PPE. Therefore, if you spend more than 15 minutes within two metres of a patient who subsequently tests positive for COVID-19, the app may identify you as being a close contact.

IF YOU RECEIVE A CLOSE CONTACT ALERT If you are a health care worker and you receive a close contact alert, you should request a call back from the contact tracing team. The team will tell you what steps to take. Always follow HPSC protocols and any local guidelines on what to do if you are in close contact with someone who has tested positive for COVID-19.

Download the app here: https://covidtracker.gov.ie/ You can find out how to switch contact tracing on and off at www.hse.ie

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COVID

Getting a COVID-19 test is never a pleasant experience, especially for young children. But one member of the National Ambulance Service (NAS) swabbing team has been making sure that he can make it as fun for them as possible.

From day one of the COVID-19 pandemic, the National Ambulance Service (NAS) crews of EMTs, paramedic and advanced paramedics have been doing community swabbing in private houses.

Joe Mooney, an Advanced Paramedic based in Dublin, explained that this service was designed for patients that are Pictured: Joe Mooney with his COVID-19 medal which he and his unable to make it to a static site, for colleagues were presented with example, palliative care patients or by management of the National Ambulance Service for their work patients with medical conditions that throughout the pandemic. make it difficult for them to get to the community testing centre.

“One of the challenges we faced early on and still do is the swabbing of paediatric patients that have been referred for a swab, It can be worrying for both parent(s) and child, so we try and make it as fun as possible,” he said.

“When I get the list of homes that are due a swab that day, I will look at the date of births and see if I have any children on the list. I will than ring the parent and explain that I will be with them in the coming hour or so to do the swab. If the child is of school-going age I might ask their teacher’s name before I arrive,” said Joe “On arrival of the house I will have a mask on and all the paperwork sorted and the rest of the PPE that I will put on in the hallway/lobby. I usually at this point tell the child that their teacher rang me this morning and told me that they are the best boy/girl and that I was asked by the teacher to come and look after them. They usually love that I know their teacher’s name.”

Joe makes a big joke out of all the PPE that he has to put on, making a game out of it to get the children laughing and their mind off the test.

“As I put on my PPE, I usually tell the child that the mask makes me look like a duck (FP2 mask) and the gown is like a clown outfit. I also tell the children that the visor I put on is so my big nose stays in the mask (I really do have a big nose). I then tell them that my gloves are sometimes naughty and snap my hand like a crocodile and I snap the glove and say to the child will you tell the gloves to be good and then they will stop snapping my hands. This usually has the children laughing.

“I will explain the process to both parent and child and show both the swab(s). If they are very young I will see if they will sit on their parent’s lap and I will ask the parent to wrap one arm around their child’s arms and hold their head with the other hand (like when the GP is taking their temperature).

“After I have completed the test I will see if the child will give me a ‘high five’ or ‘fist pump’ -while still in full PPE. I will take off all the PPE at the door and will leave while waving to the child.”

Since late October, there are new swabs for children and the swab teams are also swabbing children under one only in the nose and only 1cm up the nose. From one year to 13 years of age, they do 3cms in the nose and over 13 they do the oral and nasal swab.

“The National Ambulance Service are in the communities around Ireland doing COVID swabbing for the most vulnerable people, as well as providing emergency pre-hospital care, and its truly an honour to be part of the team,” added Joe.

NEW LAB AND SWABBING POD COVID-19 testing capacity at University Hospital Limerick will be boosted by 70%, with two new emergency construction projects that form a significant regional component of the Government’s national pandemic strategy.

The works include a purposebuilt COVID-19 laboratory, due for completion in early 2021, as well as a swabbing pod for hospital staff and pre-operative patients that opened in mid-October.

Costing approximately €4m, the new COVID-19 lab will provide purposebuilt physically separated areas for the four stages of the polymerase chain reaction (PCR) technique for DNA analysis.

When fully operational, the new lab will increase by 150 tests per day UHL's existing daily test capacity of approximately 200-220 tests.

With build-completion targeted for the end of January, and expected to become operational in Q1 of 2021, construction of the rapid-build modular laboratory commenced in mid-September, on a site to the rear of the hospital previously occupied by haemovigilance and quality portacabin offices.

Dr Patrick Stapleton, Consultant Microbiologist at UHL, said, “The UHL laboratory operates one of the busiest hospital COVID testing services in the country. Staff in the UHL serology and microbiology laboratories, supported by all laboratory disciplines, have built from scratch a COVID testing service that has consistently delivered fast, accurate test results for people attending UL Hospitals and for people in the local community. The recent welcome developments in buildings and equipment will allow our staff to continue to meet the intense demand by automating some labour-intensive steps in COVID diagnostics, and will permit further expansion in test capacity. The move to a purposebuilt laboratory will greatly enhance molecular laboratory diagnostic capacity in the Mid-West during the pandemic and beyond.”

Dr Patrick Stapleton, consultant microbiologist, UHL.

TESTING FOR KIDS

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Profile Left: CEO Paul Reid Right: Lisa Glynn, Advanced Nurse Practitioner in Respiratory, Tallaght University Hospital

AND THE WINNER IS...

HSE STAFF CEO Paul Reid accepts the EY Entrepreneur of the Year Special Award on behalf of HSE staff CEO Paul Reid attended the virtual EY Entrepreneur of the Year Gala Awards as a very special guest last month. Recognising the contribution of our frontline staff to the fight against COVID-19, Paul was asked to represent the staff in accepting a special award for their outstanding service to the country.

The EY Entrepreneur of the Year Awards covers the entire island of Ireland. The annual awards are Ireland’s longest running recognition programme. Supporting, advising and connecting a community of entrepreneurs, throughout Ireland. This is the twenty third year of the programme and its mission is to promote, celebrate and support entrepreneurship across Ireland, and celebrate the positive contribution entrepreneurs make in the Irish economy and around the world.

"THE PUBLIC HAVE A RENEWED SENSE OF TRUST IN THE HSE STAFF, AND THIS AWARD IS RECOGNITION OF THE TIRELESS WORK YOU CONTINUE TO DO TO KEEP PEOPLE’S FAMILIES AND COMMUNITIES SAFE.”

Each year the achievements of one individual who has contributed in a meaningful way to the benefit of the entire island is chosen by EY. Previous winners include; Senator Martin McAleese (2010), Fr Peter McVerry (2015), Aoibheann O’Brien and Iseult Ward of Foodcloud (2017), and Joe Schmidt, Irish Rugby (2019).

Acknowledging the unprecedented times we are living through, this year EY are changing the parameters of this award. For the 2020 special award they are recognising four representatives across the front line. Paul Reid was presented with this award for his role in leading the public health response to the coronavirus pandemic and as a representative of all health front-line workers.

Speaking on the honour of accepting this award, Paul said, “Congratulations to all of you on receiving this prestigious award. COVID-19 has negatively impacted our lives in 2020 but one positive outcome from this pandemic is that the public have seen how much we care and we have shown how we respond in times of extreme crisis. The public have a renewed sense of trust in the HSE staff, and this award is recognition of the tireless work you continue to do to keep people’s families and communities safe.”

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Lifestyle

RELOCATION RELOCATION RELOCATION In April this year the HSE entered into an arrangement with the private hospital sector to avail of capacity in private hospitals as part of the overall response to the pandemic.

As part of this plan, the Galway University Hospitals’ Rehabilitation Service, which is based on the Merlin Park campus in the east of the city, was moved to the Bon Secours Private Hospital, 3km away. The move involved the transfer of 19 patients who were participating in active rehabilitation in Merlin Park. Additional patients were transferred from University Hospital Galway (UHG) every week during the 12 weeks and many were discharged directly home having completed their rehabilitation. At the end of June, 23 patients transferred back to Merlin Park to continue their rehabilitation journey and treatment. Three medical staff and 13 allied health professionals, including physiotherapists, occupational therapists, medical social workers and a speech and language therapist, moved to the Bon Secours from Merlin Park. The nursing staff from the Merlin Park Rehabilitation Service co-ordinated the transfer of patients and ensured a detailed rehabilitation-focused handover to the Bons team before redeploying to support essential services on the UHG campus. Huge effort was provided by the IT and Medical Records Departments to ensure information systems and patient records interfaced and were linked in across both hospital sites. Some areas of the Bon Secours Hospital had to be adapted to accommodate the needs of the Rehabilitation Service. It was an unprecedented time in our health service and staff and patients demonstrated an ability to quickly adapt to an unknown and evolving situation and showed great flexibility in working around any challenges posed by the temporary relocation.

Front from left: Caitriona Conroy, social worker; Sinead Duddy, occupational therapist; Aine Cleary, clinical nurse manager; and Alma Brehony, clinical nurse manager. Back row from left: Eileen Carver, physiotherapist; Hannah Loughnane, speech and language therapist; Joan Moynihan, physiotherapist; and Eva Cantillon, occupational therapist.

Eileen Carver, Senior Physiotherapist, Merlin Park University Hospital Our greatest challenge was not having the therapy space that we were used to and that set limits on how much we could advance the patients. There was very much a problem-solving approach to any capacity or environmental issues. We do have to commend our colleagues in the Bons who went above and beyond to help us resolve any issues and all staff demonstrated a can-do attitude that honestly was inspiring. The working relationships within Merlin Park interdisciplinary teams have strengthened and made us appreciate what we have to offer as a team.

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Lifestyle

ON THE BIG MOVE OT AND PHYSIOTHERAPY STAFF FROM BOTH HOSPITALS SPOKE ABOUT THEIR EXPERIENCES

Sinead Duddy, Occupational Therapist, Merlin Park University Hospital We found the entire staff from the Bon Secours very welcoming and eager to learn how to deliver the kind of quality care needed by patients during their rehabilitation. They engaged positively, asked questions and took on board what they learned from us and implemented it. This was very reassuring as there was a certain fear of the unknown for staff and for patients particularly as we would no longer be working with our nursing colleagues and instead would be merging with the existing Bons staff. The Speech and Language therapist and Social Workers, new services to the Bons, were essential to the rehabilitation of our patients and MDT working. Where there were challenges, we found solutions. What worked really well was having all our OT staff together working in one location - in Merlin Park we are usually divided between 2 locations at opposite ends of the campus. By operating out of one OT department in the Bons we could manage workloads, support each other and work more efficiently as a team. Within days of the decision being made to move our service and our 19 patients, we had moved. It was stressful and challenging but we did it. The collaborative, dedicated team work from both the Bons and HSE teams made it work. We’ve seen that with the right momentum we can do the near-impossible when it matters while also keeping our patients safe and delivering high quality care.

Philomena Martin, occupational therapy manager. with Sinead Kilcourse, physiotherapist, Bon Secours Hospital, Galway.

Philomena Martin, Occupational Therapy Manager, Bon Secours Hospital, Galway: I knew that it would be a challenge but was very much looking forward to it. Having worked in the HSE and rehab in the NHS, I knew what changes were necessary within the Bons OT service to make the transition as smooth as possible for the Merlin Park team. My initial challenge was acquiring and resourcing a suitable space for the service to be effective, and then to make sure that the HSE personnel were quickly integrated into their new working environment. The positive attitude of the Merlin staff, and the strong level of communication between us, helped me to develop the new department to ensure we provided the same high standard of care that the rehab patients were accustomed to. The experiences shared have resulted in a closer relationship between the two OT services, as well as creating a bond between the individuals involved, and this camaraderie has already seen a dynamic sharing of good practice among us.

Sinead Kilcourse, Physiotherapist, Bon Secours Hospital, Galway The physiotherapy team was made up of two teams – the team from Merlin Park and the team from the Bon Secours. Each team had three to four physiotherapists and one to two physio assistants. In addition, there was a separate outpatient team from the Bon Secours, comprising two physiotherapists. The Bon’s team has experience primarily in elective orthopaedics and acute medical patients with little rehabilitation input due to the acute nature of the hospital. The Merlin Park team were amazing when they arrived. They slotted right in and gave us training on stroke rehabilitation and the role of Occupational Therapy (OT) and Speech and Language Therapy (SLT) early on. They were on hand all the time to help with our queries and often saw patients with us; helping us progress their treatments and aim for discharge. We really enjoyed working and learning from them. We appreciate that it wasn’t easy to leave their work environment for a new location, whilst we were nervous about our skill level in treating patients in a rehab setting. We quickly became a very close team and we are so appreciative for their wealth of knowledge. We were truly disappointed to see them leave at the end of June. We really have come away with a new set of skills we can implement in our setting going forward and will always be indebted to them.

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Lifestyle

LIVING WELL EMPOWERING PARTICIPANTS The online Living Well, a group education programme for adults with long-term health conditions, has been launched. A video explaining the programme was shared widely on social media on the day of its launch and features the voices of people with firsthand experience of Living Well.

M

ary Shields, Living Well facilitator (and former participant) said, “The emotional support participants give each other is tangible and empowering, regardless of what their condition is. It is very rewarding, over the six weeks, to see participants grow in confidence and develop a sense of control over their health conditions and their lives.” This Chronic Disease Self-Management Programme has been available in Ireland since 2005 under various names. In 2019, six Community Healthcare Organisations (CHO) received Sláintecare integration funding to deliver this programme under the name Living Well. More recently Cork Kerry Community healthcare have decided to prioritise the delivery of Living Well. Back in spring 2020, Health Matters featured an article on Living Well. Who would have known back then the changes that were ahead?

Prior to COVID-19 this programme was delivered face-to-face in a community setting in groups of up to 18 people. In order to continue delivery of this evidence based programme while protecting at-risk people it became clear that Living Well needed to move online during the COVID-19 pandemic. This shift to online delivery presents both advantages and challenges for those delivering the programme but also for those participating in the programme.

Wh at is L iv in g Wel l ?

Living Well is a free, evidence-based, group, selfmanagement programme for adults with long-term health conditions. It supports people to develop practical skills and confidence so they can manage their health condition better and make changes for a healthier life.

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Lifestyle

WHAT DOES LIVING WELL ON-LINE INVOLVE?

It involves attending one workshop every week for six weeks. Each workshop lasts 2.5 hours. Participants must have internet access and a piece of suitable technology (laptop with camera and microphone or tablet or smartphone)

There is an introductory session before the 6 week programme which supports people to get online.

Throughout the programme, support is provided to help participants stay online

Workshops are delivered in a relaxed and friendly way so that all participants can learn from each other. There are a maximum of 12 people in an online programme

Two trained facilitators run the workshops each week. At least one of the facilitators lives with a long-term health condition

Wh at h ave p e o p le sa id a b o u t t h e p ro g ra m m e?

“Seeing how other people live and manage every day – when they also have long term illness challenges was useful.”

“I met wonderful people with other illnesses and this made me feel ‘not alone’ which helped me emotionally.”

“My confidence has increased and I feel I am now able to manage my condition better”

LIVING WELL ON-LINE AND SAFELY Between January and October 2020, 357 people have participated in Living Well with many of these doing so online. People have expressed thanks that they were able to do it from the safety of their own homes. Since March, many people with long term health conditions have been advised to take extra precautions and many were advised to cocoon. This has led to feelings of worry and stress. Living Well has proven to be effective in helping people to deal with difficult emotions, to understand and learn more about managing their condition, set goals, problem solve and make plans to live a healthier life.

FIND OUT MORE ABOUT LIVING WELL IN YOUR AREA

Further information about the programme including the launch video and information on how to register or to refer can be found on www.hse.ie/livingwell

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Staff Support

A listening ear for staff The Employee Assistance Programme is there to help health service staff with their mental health. Its role has been invaluable during COVID-19, says counsellor Ann Callanan.

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each out for support, you are not on your own. Those are the words of advice from a counsellor who has been helping health service staff with their mental health as part of the Employee Assistance Programme.

Ann Callanan, a counsellor with the programme since 2006, urged HSE staff struggling with the stresses brought on or exascerbated by the COVID-19 pandemic are being urged to get in contact.

She highlighted the value of speaking to a counsellor familiar with the unique pressures of working in the health service.

“Having a confidential space within the organisation is really important to staff. A regular piece of feedback that we receive is that staff value the validation they get from being heard, by someone who understands the workings of the HSE. I think we give staff the opportunity to be heard, without having to shout,” said Ann. “I feel that the emotional burden that HSE staff carry with them, because of the nature of their work, often goes unnoticed. A service like EAP is key to shining a light on this, and supporting staff to prioritise their wellbeing, while they’re taking care of others. I focus a lot on self-care, which, on the surface sounds like a great idea! But the reality is that self-care is hard work. It’s difficult to prioritise it and it’s difficult to maintain it. Accessing our service gives staff the space to think about the challenges they experience, and can provide a

framework for making it happen.”

She said the pressure of COVID has seen the demand for the service increase.

“We’re noticing that more staff are getting in touch directly, or their managers are getting in touch on their behalf. I notice it in the volume of emails and phone calls, and our waiting time for a first appointment has increased. It took a while for us to see the increase,” said Ann. “In the beginning, I think staff were taken up with meeting the challenges that faced them in the short-term, and simply got on with it. HSE staff are incredibly dedicated to their work and to the patients and service users they meet. But over recent months, they’re starting to experience the fall-out, and have been getting in touch with our service for support.”

She explained that ‘moral injury’ is emerging more as COVID goes on.

“This is where staff are in a position to make decisions that go against their own values. It was originally expected that staff in ICU wards would experience it. But I’m finding it’s a significant issue for staff, particularly in the community, who are severely restricted in delivering their service,” said Ann. “A lot of the community teams, such as OTs and SLTS, have been redeployed to work in Contact Tracing. The small team left in the community have found themselves with an overwhelming caseload. That’s a huge burden for them to carry.”

She said that other issues include

the challenges in working from home, such as isolation from colleagues, and noted that any problems that were present before COVID have simply been exacerbated.

Ann explained that her day typically centres around the one-to- one counselling sessions with staff. These make up the core part of the day.

“There’s quite a lot of variety in this part of the job as staff seek support for a lot of different reasons. Some come for support with personal problems, such as relationship difficulties, or bereavement, general anxiety. Others come for work-related issues such as bullying, work stress, grievances or

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Staff Support "REACH OUT FOR SUPPORT, YOU ARE NOT ON YOUR OWN."

Ann Callanan

feeling overwhelmed with life,” said the counsellor.

“Another part of our work is supporting teams of staff following traumatic events, such as the sudden death of a patient, or an assault at work. This involves CISM debrief sessions, which give staff the space to process the event from an emotional perspective and reflect on how it impacted on them. We try to normalise their reactions and support them to look after themselves.

“After that, we might have some calls with managers who have a query about a staff member. I’m part of a team of staff that covers the EAP

service across the country, and we link in regularly. We have weekly team meetings and a monthly reflective practice group.”

As for who counsels the counsellor, Ann said that getting out and about helps here to distress.

“I’m a bit of a cliché – I make sure that I get fresh air and exercise.

Heading into winter I’m really trying to get some exercise a few times a week during daylight hours. I love the Japanese practice of forest bathing, which is spending a few minutes, simply sitting in the woods. It’s such a simple thing, but it just resets me,” she said.

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Staff Support

Helpline proves lifeline for staff The Healthcare Workers COVID-19 Helpline first opened back in March to help provide answers to vital staff questions as the pandemic took hold.

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hen the Healthcare Workers COVID-19 Helpline opened its phonelines back in March, it provided vital information and advice as the new virus took hold.

Mena Sheridan and Gavin McMahon are duty managers at the helpline centre, based at the Primary Care Reinbursement Service (PCRS) in Finglas, Dublin. They explained how the new service coped with the initial surge of callers from healthcare workers who, like the rest of the population, had little understanding of COVID-19.

“At the beginning, everything and everyone was in crisis mode. We just didn’t know what to expect. We initiated a training programme immediately that was quick but informative to help our call takers cope with the calls that they were going to be getting,” said Mena, who along with Gavin and the majority of the helpline staff, was redeployed from PCRS for the role.

A rota was created with 20 operators working daily. At the height of the first wave of COVID-19, the helpline was getting approximately 350 calls a day. Each shift is supported by duty managers and nurse leads.

Call-takers had a script of advice from the WHO and HSE, which was constantly updated with the most recent guidelines. There are also nurses onsite to deal with any medical queries.

“We have a system where any query that can’t be dealt with by the script is immediately escalated first to the duty manager and then, if it still can’t be answered, on to the relevant area, be it Public Health, Health and Safety or Occupational Health. We ensure that call-takers do not offer any advice of their own, they always stick to the written guidelines,” she said.

Initially, the calls they were fielding were about COVID symptoms and what they should do if they are in contact with a positive case.

“At the start, nobody knew anything about COVID so people just didn’t know what to do. They were also calling us about PPE gear and what was required of them. Those calls were very basic and straightforward. Now that we know so much about COVID in general, the calls we are getting are much more specific to that person’s situation,” said Gavin.

While the volume of calls to the helpline dipped during the summer, they again experienced a surge as the second wave hit in October.

“As the cases rose, so did our call numbers. And anytime the guidelines change, we experience a spike in calls too. At the moment, we are getting a lot of calls about the travel guidelines,” said Gavin.

Mena said the helpline has received a lot of positive feedback from the staff it has been supporting since March.

“People have told us that our advice has been invaluable to them. They have been calling us back, complimenting us for assisting them with their queries. Often we are talking to people when they are in major times of stress and they said they were very grateful that we were able to help them so quickly,” she added.

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Staff Support Adam Kelly, call operator; Mena Sheridan, Helpline manager; Gavin McMahon, Helpline manager.

BACKGROUND

INITIAL STAFFING

The Healthcare Worker (HCW) COVID-19 Helpline was established under the governance of the Workplace Health and Wellbeing Unit (WHWU) to provide advice and support to healthcare workers from the HSE, Section 38s, Section 39s and private healthcare services. Dr Lynda Sisson, Lead for Workplace Health and Wellbeing, tasked Emer Carroll, H&S Manager with the National Health and Safety Function, as project lead for the establishment and management of the HCW COVID-19 Helpline.

The Healthcare Worker COVID-19 Helpline is operating from the PCRS office in Finglas. 34 agents have been trained, with 10-12 rostered per shift. Each shift is supported by Duty Managers and Nurse Leads. For the opening times of the helpline the helpline agents has direct access to professional advice and support from; • Occupational Health • National Health and Safety Function • Human Resources • Employee Assistance Programme

PURPOSE OF THE COVID- 19 HELPLINE

ACTIVITY

The HCW COVID-19 helpline was established to provide accurate and up to date information and advice for all healthcare workers. For the purposes of this document a healthcare worker is any staff member working in a healthcare setting and can consist of staff of the; • HSE and Section 38 staff • Private healthcare facilities/nursing home • Section 39s • Dental • Pharmacies • GPs Please note contractors working in the healthcare setting can have access to the helpline.

As of November 9th 2020, the COVID -19 helpline have offered 19,856 calls and 1170 referrals to WHWU and Public Health.

The HCW COVID-19 helpline has now incorporated referrals from long-term residential care facilities (LTRF).

O p e rat io n a l H o u r s Initially opened seven days a week and now runs from Monday – Friday: 9- 5pm

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Staff Support

CAVAN GETS CHANCE TO SAY A BIG

Community donations will see the construction of an outdoor eating area for hospital staff after a year of heroic effort and dedication

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lans to build an outdoor eating area for staff were revealed as Cavan and Monaghan Hospital held an appreciation morning to say a big thank you to all the staff for their heroic effort and dedication during these past months.

“2020 has been a very challenging year for Cavan and Monaghan Hospital. No one could have predicted the tremendous change COVID-19 would have on our hospital, our staff and our communities,” said Lorraine Brady, who has led efforts to show staff how much they are being appreciated by colleagues and patients in these difficult times.

Community groups raised and donated money to go towards staff wellbeing and it was decided to build the staff outdoor area at Cavan Hospital with the funds.

“After speaking with staff it was clear that staff wanted an outdoor eating space; a space where rest periods could be enjoyed in the fresh air therefore an outside eating area with some planting is being planned and we hope for it to be ready in early the spring. A local sculptor has been approached to commission a piece of memorabilia to remember those we have sadly lost during COVID-19,” she said.

A coffee and scone morning was held in both hospitals as a gesture of thanks to staff. Staff were gifted with a customised Cavan and Monaghan Hospital takeaway coffee cup, displaying the #Holdfirm logo which was inspired by the words of President Michael D Higgins poem ‘Take care’.

A staff appreciation video was launched on the morning also, a collaboration of photographs and videos taken during COVID-19, combined with messages of thanks to staff for all they have done and continue to do during the current pandemic. The hospital choir

provided the backing music for the video, singing ‘You have a Friend in Me’ which is indicative for the ‘togetherness and care’ that staff have shown each other throughout COVID-19.

Lorraine said they were ‘blown away’ by the gestures of goodwill during this pandemic; from the donations of PPE from local businesses and schools; the donations of meals, baked goods, confectionary, ice cream, and toiletry products; self-care packages for patients; the individuals who manufactured PPE; the ladies who crocheted hearts; the artists who volunteered their art for patient cards; the donations of tablets to allow patients communicate with their families; to the generous financial donations received from various fundraising initiatives for frontline staff.

“In March 2020, a beautiful photograph was taken by healthcare assistant Orla

Mooney. Whilst sorting out PPE in the hospital basement, Orla could hear chirping sounds and came across a bird’s nest with three newborn chicks. The image is a beautiful reminder of new life, hope and the beauty of nature. Orla has kindly gifted us this beautiful image, which will serve us as a reminder of the busy time the health service has gone through. We have named the chicks ‘P’, ‘P’ & ‘E’!” added Lorraine.

To see the video, check out their Twitter page @CavanMonaghanH1 or at https://m.youtube. com/watch?feature=youtu. be&v=gDb7h6NhJy4

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Profile

MY STORY LIVING WITH A STUTTER Young Kildare woman Sandra Kelly is the picture of self-confidence.

But behind her bright smile, she bears all the mental scars of life with a stutter.

In order to help shine a light on the daily challenges that people living with a stutter have to endure, Sandra recently did what many of her fellow sufferers might have thought impossible – she did a live interview on one of Ireland’s most listened to radio programmes, the Ryan Tubridy Show.

“I did the radio interview recently with Ryan Tubridy because I wanted to highlight with people about the discrimination that people with a stutter often receive in society. I get laughed at in to my face in shops and restaurants. I feel I get constantly intimidated by people who label me as ‘stupid’,” said Sandra, a Clerical Officer with the Mental Health Service CHO7.

She feels that part of the problem is that people are not educated about stuttering.

“Stuttering is not classed as a disability but I would like this changed. People seem to think that stuttering is something to laugh at.

Until you stutter, you have no idea the torture of being lost for words.

It is a dreadful cross to bear. People need to be a bit more kind towards each other,” explained Sandra.

Sandra first started to stutter at the age of about three. She was brought to speech therapy at a very

young age but this did not help her in any way. Primary school was not so bad but the trouble started in secondary school.

“I was bullied badly by other students, who constantly mocked how I spoke. Although I was very academically bright in school, I felt that I was labelled as stupid and not intelligent. I took a job in a fast food restaurant after I finished school because I felt this was all I was capable of,” she said.

“I used to carry around a pen and notebook in my handbag and used this to write down things like if I needed a bus ticket, I would write it down and hand it to the driver. This saved so much humiliation. I only ever ordered chicken nuggets and chips anywhere I went because this was all I could say.

“Because the hardest thing to say for a person who stutters is their

"I COULD NOT SAY MY ADDRESS, SO I USED TO GET THE TAXI TO DROP ME OFF AT AN ADDRESS NEAR WHERE I LIVED AND I WOULD WALK THE REST OF THE WAY."

name, I would often tell people my name was something other than Sandra. Things like getting a taxi home from a night out was a massive problem. I could not say my address, so I used to get the taxi to drop me off at an address near where I lived and I would walk the rest of the way. For many years, my mobile phone was used only for text messages.”

She explained that people finishing words and sentences for people who stutter is a huge issue for her.

“It makes you feel so stupid and so intimidated,” said Sandra.

Sandra took part in the McGuire Programme, run entirely by people who stutter, back in 2004.

“When I walked in to the room on the Wednesday evening, it was the first time that I have ever met another person who stutters.

The programme is not a cure for stuttering, but if you work hard, you can train yourself to speak through the costal diaphragm that people use for singing. This programme brought me a lot of positive things over the years. I did public speaking on soap boxes in busy shopping streets, radio interviews, and newspapers articles.

I was also a primary coach on the programme for many years. It also gave me confidence to get my job with the HSE.” F in d o u t m o re www.mcguireprogramme.com/en

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Flu Vaccine

DO IT FOR THE KIDS All children aged 2-12 years can receive the influenza vaccine free of charge from their GP or pharmacist.

The vaccine is given as a nasal spray and the children’s nasal influenza vaccine programme is now well underway across the country.

Dr Chantal Migone, Specialist in Public Health Medicine, and Dr Tom Barrett, Senior Medical Officer, shared the most common queries they are dealing with in the HSE National Immunisation Office.

WHY ARE CHILDREN BEING OFFERED INFLUENZA VACCINE THIS AUTUMN? Children are more likely than adults to catch influenza. It is estimated that 20-30% of children develop influenza during each influenza season compared to 5-10% of adults. Flu in children can cause pneumonia, bronchitis, and painful ear infections (otitis media), croup and bronchiolitis in children.

Influenza can also make chronic diseases like serious heart disease or asthma worse. This means that influenza can make children seriously ill. Over the last 10 years, more than 4,750 children have been hospitalised as a result of influenza, 183 children needed treatment in intensive care and sadly 41 children have died.

HOW IS THE FLU VACCINE GIVEN TO CHILDREN? The flu vaccine for children is given as a single spray in each nostril of the nose. There is no needle or injection, so it is simple and quick to get the vaccine and pain-free.

The nasal flu vaccine is more effective in children than the injectable flu vaccine so that’s why this vaccine is being given to children.

ARE THERE ANY OTHER ADVANTAGES TO THE FLU VACCINE FOR CHILDREN? Vaccinating children against flu also protects the wider community.

Children carry the flu virus in their systems for longer than adults, and so can transmit influenza virus for a longer period than adults.

Vaccinating children against flu protects them, but also protects people they come into contact with like their siblings, parents or grandparents. Protecting children and the wider community against flu is especially important this year.

Preventing influenza means that fewer people will need treatment for flu, and so will help our health services that are under pressure as a result of COVID-19.

ARE THERE ANY SIDE EFFECTS FROM THE NASAL FLU VACCINE? The most common side effects are mild and include a blocked or runny nose, muscle pains or a mild fever.

These side effects generally go away themselves in a few days. Serious allergic reactions are very rare and happen in about 1 in a million people.

WHERE CAN I GET MORE INFORMATION ABOUT THE CHILDREN’S FLU VACCINE? There is a lot of information available online and from other sources about vaccines, and not all of it is accurate or true. So it’s important that information about vaccines comes from a credible source.

You can find information on the website of the National Immunisation Office website immunisation.ie or www.hse.ie/flu

SINÉAD CREEDON, who has just taken on her new role as the Infection Prevention and Control Clinical Nurse Specialist for Cork University Maternity Hospital (CUMH), reminded people that the majority of flu infections are asymptomatic and healthcare workers are often the likely source of infection. Ireland South Women and Infants Directorate has set a Directorate-wide target of 95% uptake of the vaccine this year. Last year the national uptake was 59% but CUMH’s uptake was 38%. “It is imperative that each of us thinks very carefully this year about our duties and obligations, both as healthcare workers and fellow human beings, as we battle together against COVID-19. Although not mandatory, the Medical Council of Ireland state ‘it’s your duty to protect yourself from common infectious diseases’ and the Nursing and Midwifery Board of Ireland (NMBI) recommends influenza vaccine for all nurses and midwives,” said Sinéad. The Centre for Disease Control undertook a systematic review and concluded that healthcare worker (HCW) vaccination can enhance patient safety. One of their studies showed a 40pc reduction of influenza related deaths in hospitals with higher rates of HCW influenza vaccination. This year CUMH is launching ‘Shot on the Spot’, the influenza peer vaccination campaign, which Sinéad hopes will have maximum impact this year.

“Anti-vaccination is nothing more than a ‘belief system’. It is based merely on stories on what people think and believe, in the absence of any medical or science-based evidence,” she said.

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BRIAN ARTHUR

Flu Vaccine

LEFT TO RIGHT: Christine Ryan RGN, Roisin Murphy Health Care Assistant, Rebecca Cooke MTA, Dhivyal Plakkal Asst. Director of Nursing, Donncha O’Callaghan, UNICEF Ambassador, Noel O Brien Maintenance, Sharon Byrnes Administration, Caroline Collopy Health Care Assistant, Carol Desmond, Allocations Liaison Officer, Midwifery, University Maternity Hospital Limerick, Fiona Rigney Practice Development Co-ordinator, Old Persons Services

"WHEN YOU EDUCATE PEOPLE, YOU EMPOWER THEM" MARTIN SMITH, ‘FLU CHAMPION’ OUR LADY OF LOURDES HOSPITAL, DROGHEDA

Martin Smith, the ‘flu champion’ at Our Lady of Lourdes Hospital in Drogheda, was full of praise for the efforts of his colleagues, nearly 92% of whom opted to get the vaccine last winter, earning the hospital a national award. This is Martin’s fifth year at forefront of the flu vaccine campaign in the Lourdes. When he took on the role, the hospital was averaging an uptake from just 14% of staff.

“I could see that there were barriers that needed to be overcome to get people to buy into the vaccine and to see the value of it. The major one was tackling the myths and legends surrounding the vaccine itself. When you would hear people tell one another, ‘Oh I got the flu vaccine and two days later I got the flu’,” explained Martin.

To counteract the misinformation surrounding the vaccine, the hospital arranges education sessions, as well as one-to-ones.

“The one-to-ones are really important. We have a small enough staff of around 3,000 people so everyone knows everyone. That allows me the chance to stand and talk to colleagues and I can chat to them informally about the vaccine and any worries they may have about it. It’s very much about the personal touch.”

He insisted that you cannot pressurise people into getting the vaccine, instead he sees the friendly and persistent approach as the most productive.

“People here know that it’s going to be a bit of fun. The staff laugh and joke when they see me coming or when I’m going around putting the posters up. One was joking that there was no hiding place from me,” said Martin.

He said that there has been very much a culture change in the hospital in the last few years and people wear the special lanyard

that shows they have gotten the vaccine like a badge of honour.

“People are very proud of the hospital and are invested now in how we are performing. They will ask me what number we were at and how we were comparing to other hospitals. And they can see that the onus is on them to get the vaccine to protect themselves, their patients and their families. That’s the big change,” he said.

Martin Smith

DO IT FOR EACH OTHER ...

HSE Mid West Community Healthcare & UL Hospitals Group have joined forces to combat the flu! Both organisations have teamed up with UNICEF for the ‘Get A Vaccine, Give A Vaccine’ initiative. This means that for every flu vaccination given to our healthcare staff, the Community and the Hospitals Group are giving the cost of 10 measles vaccines to UNICEF for vulnerable children in the developing world.

At a time when COVID-19 has caused the shut-down of many immunisation programmes in the developing world, every staff member who protects themselves against flu is not only protecting their patients, colleagues and families, but also making a crucial contribution to the UNICEF effort to provide children in need with life-saving protection from measles.

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Flu Vaccine

PEER TO PEER VACCINATIONS

Orla Kavanagh, Director of Nursing, University Hospital Waterford

35 trained and active peer vaccinators are the key to University Hospital Waterford’s (UHW) huge improvement in the uptake from staff of the annual flu vaccine. Last year, 68.8% of staff at the south-eastern hospital got their flu jab, a rise of 21.4% from the previous year. Director of Nursing Orla Kavanagh explained that the level of activity from the peer vaccinators on the staff has been the secret to their success. “We have 35 peer vaccinators active in the hospital at the moment. It means that staff have access to the flu vaccine 24 hours a day, seven days a week. And not only do we have our flu vaccine clinics, we have mobile vaccine stations where the peer vaccinators can walk around with their trolley and bring the vaccine with them to the clinical areas so staff don’t have to leave their work area,” said Orla.

The hospital has an Influenza Governance Group which meets every seven to 10 days to monitor the uptake and plan ahead. “We meet very regularly and it allows us to have data in real time and constantly monitor progress. We can see which disciplines or areas

in the hospital that haven’t been as active in getting their vaccine and target those areas. If the uptake drops in a particular week, we can start looking at new incentive campaigns that we can work on,” said Orla, who has secured prizes for staff to enhance uptake.

Clinical Placement Coordinator Gemma Poole is the flu champion for UHW and rosters the vaccinators to maximise the availability of the vaccine for staff. Orla noted that there has been a greater appetite for the vaccine this year since the pandemic hit. “People are a lot more cautious this year and are much more aware of flu or COVID-like symptoms. They are definitely a lot more keen to be protected and to protect other people by getting the vaccine,” said Orla.

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A new initiative that cuts through the paperwork has proven a massive boost to the uptake of the flu vaccine among staff in the Dublin Midlands Hospital Group (DMHG). Their Online Flu Vaccination Consent Form (FVCF) was introduced as an ‘Innovative Digital Health Solution’ for the 2019 to 2020. The objective of the online FVCF was to use a digital platform to cut the amount of time it had been taking in the paper-based system. The system has two access links, one which is the FVCF for all healthcare workers to complete and submit their consent. The form requires some demographic data and asks questions on allergies and fitness/wellness to receive the vaccine. The other link is for peer vaccinators to have visibility in their hospital for healthcare workers who completed the form. Each peer vaccinator is loaded onto the system in advance.

Once the form is checked and submitted, the vaccine can then be administered and the form electronically signed. Last year peer vaccinators details were uploaded onto the system centrally. This year local hospitals were enabled to do this, giving the Flu Leads more control over the system.

While there were a number of contributing factors, the online consent form and data collection capability was core to the 7.4% increase in vaccination for the 2019/2020 flu season.

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ONLINE CONSENT

Eileen Whelan, Chief Director of Nursing & Midwifery & Quality, Dublin Midland Hospital Group, completing the DMHG Online Flu Vaccination Consent Form.

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Antenatal

ANTENATAL EDUCATION CLASSES

GO ONLINE New National Forum set up to support midwives to provide local antenatal education during pandemic

COVID-19 has presented many challenges to us all personally and professionally and it has been an especially difficult time with increased anxiety for pregnant women. In response to the sudden suspension of face to face antenatal education during the pandemic, a National Antenatal Education Forum was set up in April by Margaret Quigley, National Lead Midwife, Office of the Nursing and Midwifery Director (ONMD). With rapid changes to maternity and clinical care guidelines nationally, existing processes of delivering antenatal education had to be re-designed.

Initially the Forum was intended to explore the possibility of developing a national online antenatal education course for use by midwives and public health nurses. It was quickly realised that online initiatives were already underway in some units around the country. In addition, feedback from midwives working at the frontline expressed the women’s desire to maintain connection to their own local midwives. Midwives themselves wanted to preserve their personal interaction with women and partners.

To meet these needs the Forum subsequently concentrated on supporting and enabling midwives to deliver local education and enabled antenatal educators to collaborate at national level and share ideas and learning. The HSE online resource www. mychild.ie, the HSE ‘My Pregnancy’ book and the recently launched HSE National Standards for Antenatal Education in Ireland were a constant and reliable source of guidance for midwives developing online antenatal education for women.

The Forum is an on-going initiative and membership includes midwives involved in local parent education provision. It provides an opportunity for antenatal educators to debrief on the challenges they have faced during the pandemic. As some maternity units were further along in delivering classes online at the outset than others, they were able to share ideas with other units that were all eager to make progress. To date, midwives and maternity units across the country have rapidly adapted to delivering virtual education and care to women whilst still maintaining that personal touch.

Initiatives designed and developed by members of the forum include:

• • • • • • • • •

online antenatal classes online postnatal classes online breastfeeding classes online infant feeding classes online Q&A sessions for parents online and phone booking visits virtual hospital tours virtual labour ward and operating theatre tours recorded video resources

Margaret co-facilitates the monthly forum with Michelle Waldron, NMPDU Officer, South East. Cathy O’Sullivan,

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Antenatal

Interim Director of the Centre of Midwifery Education, Cork University Maternity Hospital, is a founding member and provides invaluable guidance from her wealth of expertise in the area of developing, co-ordinating and facilitating an accredited academic module for providers of antenatal education. The Forum is very grateful to Anne Pardy, Lead, The Nurture Programme; and Sorcha NicMhathúna, Communications Manager, Child Health,

for their support. Loretto Grogan, Director of Nursing CIO National Lead, ONMSD, also contributed and advised on the best virtual platforms to use and on how to make connections to national and local IT resources. It was an added bonus that each of the eight Nursing and Midwifery Planning and Development Units around the country have an NMPDU Officer identified to support the maternity units with virtual and telehealth initiatives.

The Forum continues to meet monthly.

It is open to membership from all 19 maternity hospitals/units and has recently been extended to public health nurses. From a national and local perspective, it has been so inspiring to see the professional commitment and dedication of each of the Forum members to equip women and their partners with the knowledge and skills to prepare them for childbirth and parenthood during these unprecedented times.

Wh at h ave p e o p le sa id a b o u t t h e p ro g ra m m e?

“Excellent support network” “Motivational power of sharing” “Invaluable resource and sense of camaraderie” “Practical advice for practical challenges” “Troubleshooting and avoiding the pitfalls” “Non-judgemental space to share concerns and learn” “A national benchmark for own performance” “Invaluable shared learning and guidance to develop virtual classes”

WHAT’S BEEN HAPPENING: IN THE WORDS OF ANTENATAL EDUCATORS ACROSS THE COUNTRY Sligo University Hospital “Antenatal education is now provided through digital means including a virtual tour of the maternity and neonatal service. We are currently undertaking a needs analysis to assess where additional community antenatal education is required.”

Colette Kivlehan, Quality Improvement Project Midwife, Sligo University Hospital

Helen Byrt, CMM2, and Carmen Murphy, CMM2, University Maternity Hospital Limerick

University Maternity Hospital Limerick “The parent education team have all attended training sessions on using the Microsoft Teams platform and while it has been a challenge to learn an entirely new way of delivering information, it has proved successful in that classes can continue to be interactive and couples still have the chance to feel involved.”

Helen Byrt, CMM2, and Carmen Murphy, CMM2, University Maternity Hospital Limerick

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Antenatal

University Hospital Kerry “A number of antenatal educational videos were developed and launched online by the UHK maternity multidisciplinary antenatal team. The aim being to promote the facilitation of high-quality antenatal education giving consistent, researched and evidencebased messages to pregnant women their partners and families in Ireland.”

Mary O’Connor, A/CNME Director, University Hospital Kerry (with pic)

Mary Moran, staff midwife, (left) and Carmel Connolly, CMM2, (right) give a virtual class

St Luke’s Kilkenny “We encourage birth partners to attend these classes to ensure they are included.

We have developed a maternity page on the St Luke’s website with direct link pages to cover a wide variety of information to include dietetics, physiotherapy, breastfeeding, mental health and self-care, bereavement, ultrasound scanning, Covid-19 information and all antenatal education to further support women and their partners during these difficult times.”

Samantha White, AMP Midwifery Care, St Luke's General Hospital, Kilkenny Cork University Maternity Hospital “A suite of antenatal education and breastfeeding videos have been created by Cork University Maternity Hospital. From the onset of COVID-19, the website was regularly updated with video clips giving information and messages of support to expectant parents. These video clips were shared on social media.”

Cathy O’Sullivan, Interim Director, CME, Cork University Maternity Hospital

A parent taking part in a University Hospital Galway online class

University Hospital Galway “While all programmes in April were led initially by the Parent Education midwives, the full multidisciplinary team joined in May. Respect and kindness is very important during this pandemic as everyone in the team needed time and support to adjust to the new normal.”

Carmel Connolly, CMM2, University Hospital Galway

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Antenatal

Coombe Women and Infants University Hospital “Analysis of feedback from both service user and service providers after the cessation of classes indicated a gap in practice and a definite need to address this problem. Coombe Women’s University Hospital CWUH set about producing a suite of digitally recorded classes covering all aspects of antenatal education in line with the National Standards for Antenatal Education in Ireland and the development of a series of online interactive classes for facilitation through a virtual platform.”

Megan Sheppard (CMM2), Coombe Women and Infants University Hospital Mayo University Hospital “We have had to rethink the primary provision of block classes monthly for first time parents and now have started to go online providing an antenatal class and breastfeeding class. Partners and support persons are encouraged to attend the online service”.

Frances Burke, CMM2/CPC Midwifery, Mayo University Hospital

Above: Michael Roulstone, Vibrant Films; Ciara Whelan, staff Midwife, Dep. Parent Education; Megan Sheppard, CMM2, Dep. Parent Education; and Aoife Walsh, Marketing Manager, CWIUH.

Waterford University Hospital Below: Aoife Hartwell, staff midwife; Linda O’Callaghan, Clinical Placement Coordinator; and Helen Brett, staff midwife, Waterford University Hospital.

Maura McKenna, CMM2; and Frances Burke, CMM2/CPC Midwifery; ready for action at Mayo University Hospital.

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A VIRTUAL ARM AROUND BREASTFEEDING MUMS AND BABIES Lactation consultant Roisin Sullivan has been putting a virtual arm around breastfeeding mums and babies, providing vital support and advice despite the restrictions caused by COVID-19.

Roisin Sullivan, HSE Public Health Nurse and lactation consultant, hosting an online breastfeeding group in Dun Laoghaire.

Roisin, a HSE public health nurse, hosts an online breastfeeding group in Dun Laoghaire. The virtual group began a few months ago when Roisin returned to her post following redeployment to a COVID-related role. While it can’t fully replace the in-person gatherings and consultations, it has been an enormous help to parents in the area.

This year’s HSE National Breastfeeding Week in October highlighted the role of online supports for new parents.

The HSE’s ‘Ask Our Breastfeeding Expert’ online service recorded a 57% increase in demand over recent months as parents of babies born during COVID-19 restrictions sought online advice.

“With the help of Eimear Costello, I was given a license to hold a group session on line via Cisco Webex. I sent

the link to all the public health nurses in the area to share with the new mums and the day and time is the same every week,” explained Roisin.

“I try to answer any questions that come up during the session. But if a mum prefers to do a one-on-one consultation with me, we can schedule an online session together. Then I have my doll here that I can use with my special knitted boob to demonstrate proper latch techniques with the mums and address any problems they are having.

They have my number and can always get me if they have any difficulties.”

She said that mums are taking it on themselves to arrange gatherings and offer peer support to each other.

“I now encourage the mums to share the link with any other mums they know.

They have also set up a WhatsApp group amongst themselves for extra support.

Another mum has a Zoom meeting every week and I join it every fortnight to offer advice. This group have a Friday morning meet up in a park in Dun Laoghaire weather-permitting.”

She had hoped to do one or two meet ups in the park to mark National Breastfeeding Week but her plans were curtailed by the escalation of COVID-19 restrictions.

“We would always have a coffee morning with the parents to celebrate Breastfeeding Week and it was obviously disappointing that we couldn’t carry on that tradition this year. But it’s good to see that mums are still connecting with each other, even if it is through Zoom or WhatsApp. Peer support is just as vital on the breastfeeding journey,” said Roisin.

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Antenatal

BREASTFEEDING WEBINAR IN SUPPORT OF NATIONAL BREASTFEEDING WEEK 625 people sign up for online event hosted by NUI Galway NUI Galway hosted an online webinar in collaboration with the HSE in support of National Breastfeeding Week 2020. The theme of the online event was ‘Diverse global perspectives on breastfeeding and breastfeeding support.’ 625 mothers, fathers, breastfeeding supporters, health care professionals, and policy makers signed up for the webinar.

The online webinar took place on October 7th with an introduction by Sabina Higgins, who is a strong advocate for breastfeeding and breastfeeding mothers. Ms Higgins stated, “There is no greater gift to a baby than to be nursed on his mother’s milk for the first six months and beyond.” Professor Julie Smith of the Australian National University in Canberra, Australia, explained, “In sheer, raw, bottomline economic terms, breastfeeding may be the single best investment a country can make.”

The virtual webinar gave us a fantastic opportunity to share and learn from a range of highly acclaimed local and global experts.

WE’RE BREASTFEEDING FRIENDLY SLIGO ‘We’re Breastfeeding Friendly Sligo’ is an initiative which aims to improve the health and wellbeing of breastfeeding mothers, babies and their families by encouraging businesses, organisations and communities to become Breastfeeding Friendly.

‘We’re Breastfeeding Friendly Sligo’ will focus on publicly-accessible buildings and services in Co Sligo to encourage them to become breastfeeding friendly including commitment and visible statements of support for the initiative in publicly accessible spaces supported by a branding and promotional campaign.

The initiative was successful in receiving Healthy Ireland funding and is being supported by Local Community Development Committee (LCDC).

‘We’re Breastfeeding Friendly Sligo’ initiative’s Steering Committee provides oversight of the entire project. It is comprised of representatives from the HSE, Sligo FRC, Sligo Leitrim CYPSC, and Lifestart Supporting Parents Leitrim Sligo, and West Cavan CLG.

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Pregnancy

ATTEND ANYWHERE APPOINTMENTS SO CONVENIENT FOR PATIENTS Video calls instead of onsite visits bring lots of practical benefits

T

he Diabetes in Pregnancy service at University Maternity Hospital Limerick (UMHL) has served mums and mums-to-be throughout the COVID-19 pandemic, thanks to innovative ‘virtual clinics’ that provide convenient access to health services at a time when social and physical distancing remains so central to minimising the threat to public health of the coronavirus.

Staff and patients of the Diabetes in Pregnancy Service at UMHL are using the ‘Attend Anywhere’ video platform and telephone calls to conduct a total of 92 virtual consultations every week. Among service users there was some initial uncertainty about virtual clinics, and this was soon offset by an appreciation for the practical benefits from not having to arrange travel to and from hospital for the clinics, and for the safety of attending a clinic in their own personal space.

YVONNE MOLONEY, a Registered Advanced Midwife Practitioner on the Service, said that the video calls had proved very successful for a broad cross-section of patients.

“Certain patients have engaged very well with video calls, including non-Irish patients, patients who are nervous of becoming infected with COVID-19, patients travelling long distances, patients with childminding difficulties, and with difficulties accessing public transports. Patients who speak another language and have a friend or family member of their choosing on the video call, which is particularly useful at a time when family and friends cannot join them for appointments at the hospitals.”

KAREN O’BRIEN, a schoolteacher living in Cappamore, Co Limerick, approximately 30 minutes’ car journey away from the hospital, has Type One diabetes and has a son aged two. Currently attending the Diabetes in Pregnancy Service at UMHL for her second pregnancy, she says she finds the virtual clinics much easier to organise and fit into her life than the face to face consultations she had to organise during her first pregnancy. “I feel much safer, obviously, during the pandemic, and I find it great for my work because I teach, and it can be difficult to organise times for the clinics. It’s much easier to schedule a virtual clinic for a time to suit you. It only takes about 15 or 20 minutes to organise, and you’re done until your next clinic. It’s great. It’s definitely much more convenient,” Karen said. “In the past, I would have had to go for a consultation after school, so it could be after 3.30pm before I would get to the hospital, and perhaps as late as 7.30pm before I got out.”

DEIRDRE FLANNERY from Nenagh, Co Tipperary, already has a twoyear-old daughter and just two months ago gave birth to a baby boy.

Deirdre, who has had Type 1 Diabetes for 34 years, admitted that she was initially a little bit concerned because with virtual clinics, urine, blood and blood pressure cannot be tested. However, she said there was no doubt that she felt much safer to have the virtual option available. “Overall, not only is it very simple to use, it is also very secure. I know that some people might have issues with going online, but it’s all very secure. You receive your own individual, time and date sensitive access link to the video call you will have with one of the team, and that is it. I have had no problems with it or concerns about using it,” Deirdre added.

Further information is available on: https://www2.hse.ie/services/attend-anywhere/

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Lifestyle

Foetal Alcohol Spectrum Disorder (FASD)

L The recording of the webinar is now available on youtube.

Dr Mary O’Mahony is the HSE’s public health clinical lead on FASD.

etterkenny University Hospital presented their pilot practice change initiative to support women who drink alcohol during pregnancy during the Health and Wellbeing Alcohol Programme’s webinar on Foetal Alcohol Spectrum Disorders (FASD) Awareness Day in September.

Midwives reported it helped raise awareness with pregnant women on the harmful effects of alcohol on the unborn child, and resulted in earlier intervention and appropriate referral. The antenatal patient response was overwhelmingly

positive about the inclusion of information on maternal alcohol consumption within the maternity setting. Pregnant woman reported they ‘did not realise the dangers to the baby from drinking’. Overall, midwives felt the benefits of the project outweighed the extra time involved, a challenge during busy antenatal clinics.

Over 800 registered to attend the webinar which was of interest to many health service staff such as nurses, doctors, midwives, GPs, obstetricians, family support workers, Tusla staff and those who care for people with FASD. The extent of FASD in Ireland was considered. Drinking during pregnancy is common in Ireland.

Ireland features among five countries with the highest estimated prevalence of FASD. It’s estimated that about 600 Irish babies are born each year with Foetal Alcohol Syndrome (FAS) and that over 40,000 Irish persons are living with the condition.

Scotland is rolling out a national population-based service to diagnose and respond to those with FASD. Dr Jennifer Shields, principal clinical psychologist; and Dr Sarah Brown, consultant paediatrician from the Scottish national Foetal Alcohol Advisory & Support Team took the attendees through the development of FASD services and supports in Scotland.

Following the webinar, participants were invited to provide feedback and 127 responses were received, including 57 who entered additional comment.

This feedback will inform future events.

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Lifestyle

Alcohol Regulations Did you know that for the first time alcohol is being regulated as a health issue by the HSE Environmental Health Service? This is under the Public Health

(Alcohol) Act 2018. The reason for this is to protect children and young people, delay the age they start to drink alcohol and address the harm caused by alcohol in Irish society. From November 2019 alcohol can no longer be advertised near schools, crèches, public parks, playgrounds or on public transport, in cinemas or on children’s clothing. Exposure to alcohol marketing is proven to reduce the age at which young people start to drink, makes them drink more frequently and in larger quantities.

Have you noticed any changes recently in your local supermarket, convenience store or petrol station? Soon

you will see changes in the way alcohol is displayed for sale as result of Section 22 of the Public Health (Alcohol) Act 2018 which came into force in November.

Alcohol and advertisements for alcohol will be less visible and will be separated from other products in a supermarket, convenience store or petrol station.

Why do we need to do this? Alcohol is not an ordinary

grocery product and a special licence is required to sell it. There is also a direct link between alcohol and cancer. It is a factor in one in eight breast cancers and half of all head and neck cancers. Alcohol is linked to suicides, road deaths, domestic violence and accounts for approximately three deaths per day in Ireland. It is hoped that this measure will make alcohol less visible to children, give the message that alcohol is not an ordinary grocery product like bread or milk and discourage its purchase as part of the everyday grocery shopping. This is similar to actions taken in relation to tobacco products.

What next? Further provisions are coming in next year including; restrictions on promotions which encourage people to buy or drink more or faster than intended, e.g. buy one get one free, student nights, restrictions on advertising during sports events and at children’s events, restrictions on sponsorship by alcohol companies of children’s events or events involving driving or racing. Labelling with warnings of the dangers of alcohol consumption are also in the offing. The Environmental Health Service is looking forward to playing its part in implementing these provisions and have a track record in tackling issues that affect health and creating an environment where the healthy choice becomes the easier choice eg in relation to smoking, use of sunbeds etc. This work aims to help create a more balanced relationship with alcohol, reduce the harms caused by alcohol in our families and communities and ultimately improve the health of the Irish people.

W HAT CAN YOU EXPECT TO S EE? There are a number of options for shops under the legislation and alcohol will be displayed for sale in one of the following three ways

1

You will go into a separate area of the shop to buy alcohol. This area will be separated from the rest of the shop by a barrier at least 1.2m high.

2

Alternatively alcohol will be displayed for sale in closed units adjacent to each other on the shop floor. Alcohol cannot be visible up to 1.5m from the floor.

Again this is to reduce visibility for children.

3

The third option is that alcohol will be displayed openly in up to three units, each not more than 2.2m high and 1m wide. The size restrictions on the units mean that that only a limited amount of alcohol can be offered for sale. The shopkeeper may also have a closed unit behind the counter which is not accessible to customers.

The Environmental Health Service Alcohol Operational Unit has been working with retailers nationally to build compliance with this measure and it is hoped that its implementation will reduce visibility to children, give the message that alcohol is not an ordinary everyday product, discourage impulse purchasing and go some way in addressing the high consumption of alcohol in Ireland.

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Antibiotic Resistance

OVERUSE AND MISUSE OF ANTIBIOTICS

www.antibioticprescribing.ie, is a

Keeping antibiotics effective for future generations is everyone's responsibility Antibiotics are life-saving treatments when needed, but overuse and misuse causes more harm than good.

Antimicrobial resistance is a growing and significant threat to public health that is compromising our ability to treat infections effectively.

It is widely acknowledged that antibiotic resistance is driven by high rates of antibiotic prescribing and it is critical that we work to reduce unnecessary antibiotic use. Evidencebased antimicrobial guidelines are a key tool in efforts to improve antibiotic prescribing, reduce the progression of antibiotic resistance and optimise patient outcomes. The HSE antibiotic prescribing website

Pre sc r ib in g rate s Antibiotic prescription rates in the community 2018 • Ireland – 20.7 daily doses/ 1,000 population • UK – 16.3 daily doses/ 1,000 population • Sweden – 10.8 daily doses / 1,000 population • For every 4 patients on antibiotics in the UK, Ireland has 5 patients on antibiotics.

• Irish patients are prescribed twice as many antibiotics as Swedish patients.

ANTIBIOTIC FACTS 1 in 5 patients get side effects from antibiotics. Some of these side effects can be very serious, even life-threatening. Antibiotics can also cause harmful drug interactions, which can be fatal. Taking antibiotics can cause bacteria to become resistant. Bacteria are one type of bug and when they become resistant, we often refer to them as superbugs. It is much more difficult to kill superbugs with antibiotics. Ireland is in the top third of the highest antibiotic prescribing rates in Europe. 80% of antibiotics are prescribed in the community setting.In Ireland, antibiotics prescribed to those aged over 65 is increasing while figures for children and younger adults are decreasing. On a positive note, Ireland is showing a reduction in our use of broad-spectrum antibiotics especially ciprofloxacin, co-amoxiclav and clarithromycin. Residents in Irish nursing homes are more than twice as likely to be on an antibiotic as those in other European countries. Newly appointed HSE Community Based Antimicrobial Pharmacists are currently examining antibiotic prescribing in HSE Older Persons facilities.

reference source that offers up-todate guidelines for community-based healthcare professionals involved in prescribing, dispensing and administration of antibiotics.

The website has the user in mind; easy to navigate and find treatment and dosing tables as well as additional safety information such as drug interactions or dosing in renal impairment. Users will find information and guidelines on a number of health conditions; including upper and lower respiratory conditions, urinary infections, skin and dental infections. Prescribing for children is one of the most visited pages – it contains dosing tables of all major antibiotics as well as weight and height calculation and unit conversion tables. It is essential that adults and children are prescribed the correct dose of an antimicrobial as an under dose may result in the infection not being treated effectively and increased risk of resistance developing but conversely too high a dose may increase the risk of side effects and toxicity.

Led by Dr Nuala O’Connor, GP Lead, Antimicrobial Resistance and Infection Control (AMRIC), information for the website is prepared by content teams. Each content team has, at a minimum, expertise from GP practice, a Consultant in Microbiology or Infectious Diseases, an antimicrobial pharmacist and an expert in the clinical area (where applicable e.g. hospital consultant). As an example, the respiratory guidelines are currently being reviewed for the winter months. Given the variety of guidelines involved, the team involves Consultant Microbiologists, the ICGP COPD Lead and another practising GP, the National Clinical Lead for COPD, two Antimicrobial Pharmacists and a Community Pharmacist. Guidelines are reviewed and updated regularly by content teams and subject specialists.

Everyone on content teams believe in the benefit the website offers; safer and optimal prescribing of antibiotics in community settings.

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Antibiotic Resistance

ANTIBIOTICS MAKING THE CHANGE FROM RED TO GREEN The Medicines Management Programme (MMP), together with the Antimicrobial Resistance and Infection Control (AMRIC) team in the HSE, developed a preferred antibiotics initiative. It’s commonly referred to now to as the Green/ Red antibiotic list. This initiative was undertaken as part of the HSE’s drive to reduce antimicrobial resistance.

When we use antibiotics to treat illness caused by bugs most of the bugs will die, but a few bugs that are a little bit different, can survive and then multiply. The surviving bugs, referred to as ‘superbugs’ are able to block the antibiotic. Due to an overuse of antibiotics, these resistant superbug numbers are increasing in people, in animals and the environment (water and soil).

The antimicrobial guidelines for community prescribers on www. antibioticprescribing.ie recommend the preferred use of ‘green’ antibiotics. These are proven to be effective, have fewer side effects, and are less likely to lead to resistant infections than ‘red’ antibiotics.

GPs have this list as a mouse-mat to assist in antibiotic decision-making at the point of prescribing. The latest version highlights risks associated with the red agents. This year the mouse-mats have also been made available to community pharmacists to increase their awareness of the initiative. The updated mouse-mat was issued to GPs and community pharmacists as part of European Antibiotic Awareness Day on November 18th.

Each report has an educational nudge: • Report 1: introduction of green/red concept and report interpretation • Report 2: tips on safer use of clarithromycin The green agents are: cefalexin, amoxicillin, doxycycline, trimethoprim, nitrofurantoin, fosfomycin, lymecycline, flucloxacillin and penicillin V. The red agents are: quinolones, most cephalosporins except cefalexin, macrolides, coamoxiclav and clindamycin.

AMRIC are working with the Primary Care Reimbursement Service (PCRS) to build on this green/red initiative.

Since September 2019, each GP with a list of over 100 GMS patients receives an individualised report. The report shows their antibiotic use for their GMS patients for a rolling 12-month period.

The fifth report issued to GPs in early October 2020. The report details the percentage of prescribed antibiotics that are green and the percentage that are red agents. It also shows where the GP sits within a national scoring of low, midrange or high.

• Report 3: tips on prescribing for UTIs • Report 4: tips on telemedicine prescribing, COVID-19 guidelines and azithromycin feedback • Report 5: moxifloxacin safety reminder, RTI prescribing including COVID-19, web what’s new

PCRS data reveals an overall increase of 4.3% in the average ‘green’ percentage from July 2018 to March 2020: from 56.4% to 60.7%. Moxifloxacin has shown a 50% reduction in one year after the issue of a safety alert to GPs and community pharmacists.

PCRS data reports only reflect prescribing for patients with medical cards. However we have also seen significant improvements in the quality of antibiotic prescribing for non-GMS patients. Community pharmacy dispensing data from Health Market Research data for January-April 2020 vs. January-April 2019 shows co-amoxiclav down 28%, clarithromycin down 25%, doxycycline up 19%, cefalexin up 22%.

A soft copy of these educational nudges is available on www.antibioticprescribing.ie in the AMRIC key messages section.

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Cancer Screening

aBreast KEEPING

Those who have been waiting longest invited for screening first after service restarted in October

BREASTCHECK PROGRAMME RESTARTS The BreastCheck programme resumed breast screening on October 27th 2020

The focus of the restart is to achieve a maximum screening invitation rate that is compatible with a safe follow-up assessment and our treatment capacity within the health service. We are restarting by inviting those who have waited longest for screening. Invitation letters will be sent first to those who had their appointments cancelled in March and invitations for routine screening will follow. Screening will resume in our BreastCheck units on a countrywide basis.

Capacity will be reduced due to social distancing and potential staff limitations due to COVID-19. We are asking all participants, including new entrants, to check their details on the register. A new text management system is in place to maximise appointment uptake. A targeted digital information and awareness campaign will aim to raise awareness of screening, provide information on new safety measures, and encourage those who are invited to attend for screening.

Radio and other media are also planned.

Screening and Level 5 restrictions

Essential health appointments can continue at Level 5 restrictions, and we continue to encourage all participants

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to attend for screening when invited.

We are continually monitoring the effect of the restrictions, and available capacity, at all parts of the screening chain. Our clinics and mobile units are working hard to keep people safe when they go for their appointment.

This means:

• Mobile vans and static units have been upgraded to meet infection control and physical distancing requirements.

• Staff use of PPE and social distancing will be observed in both static and mobile units.

• cross-county flow of staff and participants is minimised where possible.

We are urging participants to come for their appointments when called, or to let us know they can’t make it so that we can reschedule their appointment, or offer their time slot to another person.

If you have symptoms:

Screening is for healthy people who do not have symptoms. Therefore we ask all participants to continue to be breast aware and to contact their doctor if they are worried about symptoms.

Anyone who has symptoms of COVID-19 should not attend a screening appointment until they are sure that they are clear of the illness. They should visit HSE.ie for guidelines and advice. Anyone who has symptoms of breast cancer should consult their GP without delay.

Cancer Control Programme

NATIONAL BREAST CANCER GP REFERRAL GUIDELINE UPDATED The National Cancer Control Programme (NCCP) is pleased to announce that the Breast Cancer GP Referral Guideline and accompanying e-referral form are being updated.

The aim of the guideline is to ensure that patients with symptoms most suspicious of breast cancer can continue to be seen and treated in a Symptomatic Breast Disease (SBD) Clinic as a matter of priority. There are eight SBD clinics (with one satellite clinic in Letterkenny) across Ireland, where approximately 40,000 new patients are referred by their General Practitioner (GP) each year. A referral guideline was originally developed in 2010. It is now timely for a new guideline to be developed to reflect the most up-to-date evidence. A tremendous amount of work has been carried out by a multidisciplinary stakeholder group in both the development of the new guideline and in preparation for its national implementation. It is anticipated that the Breast Cancer GP Referral Guideline and e-referral form will be rolled out in early 2021.

A n o v e r v i e w o f t h e p r o c e ss Development of the guideline The new National Breast Cancer GP Referral Guideline was developed by a multidisciplinary stakeholder group, which included patient representation. This group made a series of recommendations based on the best availble international evidence, combined with clinical expertise and patient values. These recommendations were then incorporated into a number of clearly defined, evidence-based algorithms which form the basis of the guideline. These will facilitate GPs in determining which patients with breast symptoms require referral to secondary care.

Development of the e-referral form The current e-referral form is being updated to reflect the new referral guideline. The new form will enable the GP to provide more details of the patients’ signs and symptoms so that the SBD clinic can effectively triage the referred patients.

The introduction of the new National Breast Cancer GP Referral Guideline and accompanying e-referral form will provide many benefits to all stakeholders. Risteárd Ó Laoide, National Director NCCP, said, “We are happy that work is progressing on the Breast Cancer GP Referral Guideline and are anticipating a launch in early 2021. It is a priority for the NCCP that all national cancer guidelines are developed using an evidence-based approach, which aims to improve the outcome for patients diagnosed with cancer. It is always our main goal to ensure patients are treated at the right time, in the right place and by the right people.”

For more information or for screening unit locations: Freephone 1800 45 45 55, or visit www.breastcheck.ie

As part of the project roll-out, information updates will be disseminated to all stakeholders.

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Cancer Screening

HSE SUPPORTS RECOMMENDATIONS OF INTERVAL CANCER REPORTS A new and comprehensive approach to reviews of interval cancers in our screening service

The NSS undertakes to implement fully those recommendations, in continued partnership with patients and professionals. The expert reports were commissioned as part of the Scally Review in 2018. They set out a new and comprehensive approach to reviews of interval cancers in people who have been screened by Ireland’s breast, bowel and cervical cancer screening programmes. In 2019, the HSE established two Expert Reference Groups (ERGs): one for BreastCheck and one for both CervicalCheck and BowelScreen.

NSS Chief Executive Fiona Murphy said, “An interval cancer is one that is diagnosed in a person who has been screened previously. While they are uncommon, they show how every screening programme has limitations, and cannot detect every case of cancer.

The NSS welcomes the detailed work undertaken by the expert groups, and we commit to a careful, thorough and full implementation of each of the recommendations. The terms of reference

for the ERGs set out the requirement to “define the future audit processes and review guidance for interval cancers in the National Screening Service based on international evidence and best practice”.

Following a rigorous systematic review of relevant literature, international survey findings, and learnings taken from international experts, the final reports are now complete. The expert reports acknowledge that Ireland’s screening

programmes operate to the best international standards and that they reduce deaths from cancer among people in Ireland. They affirm that world class screening programmes must balance patient trust, staff recruitment and affordability, and that interval cancers are an inherent feature of any screening programme. They emphasise the need to sustain our vital public health screening programmes.

Dr Colm Henry, Chief Clinical Officer of the HSE, said: “The HSE has now implemented more than 90% of Dr Scally’s report and this day marks an important milestone in that process. I want to thank both Prof Risteárd Ó Laoide and Prof Susan O’Reilly, and all those who worked on these reports.

Their work will contribute to improving further our screening services, which make such a real and substantive contribution to reducing the incidence of cancer in the Irish people.”

ERG RECOMMENDATIONS The ERG recommendations provide for key processes to be developed by the NSS for each cancer screening programme including: Strengthening our consent process to ensure that people understand the benefits and limitations of screening, so they can make an informed decision as to whether to partake or not. Development of clear interval cancer rate measurement within each programme. Development of blinded anonymous programmatic audits for learning and international benchmarking of standards. Access to patientrequested case reviews of interval cancers with full disclosure. Continue to build and promote the understanding of, and public trust in, the three cancer screening programmes through public information, engagement and education for participants, clinicians, and the wider society.

Update s We will continue to update our websites with details of the implementation process, which will take some time as we work through a comprehensive transformation process to meet these new aims. People do not need to take any action. We will provide progress reports on implementation to anyone who registers with us on our information line, Freephone 1800 83 21 88, or by emailing info@screeningservice.ie. When our new processes have been designed we will get in touch with people affected.

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The reports are published on hse.ie

Innovation

Empower

New Frailty Intervention Team at Roscommon empowering patients to manage their own health and wellbeing

Members of the new Roscommon Frailty Intervention Team with Denis Naughton TD at the hospital in September, from left: Dr Sri Gouda, Medical Registrar; Vanessa Gilleran, Senior Speech and Language Therapist; Fionnuala Morrissey, Senior Physiotherapist, Kate Donlon, Advanced Nurse Practitioner-Frailty; Denis Naughten TD; Dr Gerry O’Mara, Consultant Geriatrician; Sandra Burke, Senior Occupational Therapist; Martina Vaughan, Assistant Director of Nursing and Fiona Finneran, Senior Dietician.

Roscommon University Hospital has introduced a Frailty Intervention Team to provide a holistic assessment and brief intervention to patients over 65 presenting with frailty. The team is interdisciplinary and consultant-led with an Advanced Nurse Practitioner in Frailty, Senior Physiotherapist, Speech and Language Therapist, Dietitian and Occupational Therapist with access to Clinical Pharmacy and Medical Social Work.

Frailty is a combination of conditions which include weakness, exhaustion, unintentional weight loss, slowness on the feet, deterioration in physical activity and in general finding it hard to cope at home.

Kate Donlon, Advanced Nurse Practitioner in Frailty, said, “Medically well patients are seen by the team in the Frailty Clinic or Medical Assessment Unit upon referral from their GP to the hospital consultant.

“A detailed assessment takes place of each patient and based on that patient’s needs they will be referred to the

relevant team member and a treatment plan is developed with the patient and carer, if needed. Our aim is to empower patients to manage their own health and wellbeing, so they can cope at home, reduce the need for admission to hospital and continue to live a meaningful life.

“We have adapted to the current needs and where feasible virtual clinics are being offered for our vulnerable patients who have the technology, skills and support to use the video platform ‘Attend Anywhere’.”

Dr Gerry O’Mara, Consultant Geriatrician and Frailty Lead at RUH added, “For an older person, sometimes by the time they come to the hospital they have reached crisis point.

The Frailty Intervention Team aims to prevent unnecessary hospital admissions by early identification of any issues which may cause falls, low blood pressure, chest infections etc. It is a multidisciplinary approach so that each person gets an individualised assessment, ultimately to support the patient and their family as needed.”

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Brexit

HSE preparations for the impact of

Brexit T

he HSE has been preparing so that the impact of Brexit on the health service is managed and mitigated to the greatest extent possible.

The UK left the EU on January 31st, 2020 when an 11-month transition period began. This transition period ends on December 31st, 2020 and a new UK-EU relationship officially begins on January 1st, 2021.

During the transition period EU rules and regulations continued to apply to the UK and it remained part of the EU’s Single Market and Customs Union. In this period the HSE has continued to work with our partner agencies to prepare for the end of the transition stage and the changes this will bring.

MEDICINES We are working with the Department of Health, the Health Products Regulatory Authority (HPRA), pharmacists and industry to reduce and deal with any risk to the supply of medicines.

There is no need for patients, pharmacists or hospitals to order extra medicines. This could disrupt stocks and reduce the supply of medicines for other patients.

The pharmaceutical industry and medicines wholesalers, who are working closely with Government in this area, will continue to monitor future arrangements and will put any additional arrangements in place as necessary.

Anyone with an ongoing need for medicines should fill their prescription as normal.

ACCESS TO HEALTH SERVICES Irish citizens and British citizens who live in, work in, or visit the other State will continue to have the right to access healthcare there.

It is intended that other residents in both Ireland and the UK will,

subject to relevant immigration rules, also be able to access healthcare in the other State should they reside, work or visit the other State.

The government intends to introduce legislation to ensure these access arrangements can be maintained after the end of the transition period.

RECOGNITION OF QUALIFICATIONS There is an EU Directive that currently allows for Irish and UK citizens to have professional qualifications, including many health qualifications, mutually recognised. These arrangements have continued to operate during the Transition Period.

Regardless of the outcome of the future relationship negotiations, all UK qualifications already recognised in Ireland will continue to be recognised and vice versa. The same will apply to applications which are in the process of being recognised at the end of the transition period.

Future arrangements for the recognition of professional qualifications are being discussed in the negotiations on the future relationship between the UK and EU. In the event that arrangements cannot be agreed, applications for UK qualifications to be recognised in Ireland after the end of the Transition Period will be processed as ‘third country’ applications, similar to all applications from outside the EU, which may mean that the process might take longer.

If you have questions about the impact of Brexit on the health service please email us at brexit@hse.ie. Further information about preparations for the end of the transition period is available at hse.ie/brexit

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HSE CEO PAUL REID OUR REVIEW OF THE HSE’S CENTRAL STRUCTURE A review of the HSE Corporate Centre was commissioned by me earlier this year in order to put in place more effective structures at the centre to support our services across the country. We wanted to ensure that our resources were invested wisely and, as far as possible, in frontline health services. We also wanted to be ready for the changes planned under Sláintecare.

In the short time since then, our world has changed, and we are all working in ways we could never have predicted. That said, it is timely that we make the necessary changes to our corporate structure over the coming months so that our operational response to COVID-19 continues to be agile.

Our response this far to the pandemic has demonstrated a more effective way in which the centre of the HSE can work with our services. I am convinced that we all have a valuable contribution to make, whether we work in the public or voluntary healthcare sector, or indeed within private healthcare system.

We have seen: • Improved decision making and speed of response between the HSE Corporate Centre and services; • Focused problem-solving, with collaboration and innovation across the HSE Corporate Centre; • Much more open and transparent engagement with stakeholders, which has helped to build trust and confidence; • The importance of data as a powerful and indispensable tool in the efficient management of the health system; • The role of telehealth in enabling change, quickly and effectively; • Public Health playing a more prominent role in healthcare.

Our experience in dealing with COVID-19 has given us huge insight into better ways of working together and has convinced me

more than ever that we need to streamline our management processes to allow more decisions to be made by the right people at hospital and community level.

Over the past number of months I, along with EMT colleagues, have worked, with the support of EY, to develop revised structures for the centre of the HSE. Recently I provided an update to the HSE Board, and they have strongly endorsed proposed changes to our structure, and our plan to move to Phase 2 of the programme.

People function and Finance Services, Payroll and Procurement will move into the Finance function.

• To allow for automation and greater efficiency, all national schemes and reimbursement services will be combined under one function.

• Change management and process improvement activities moving under a Change and Innovation function in Healthcare Strategy.

What’s Next?

Changes Given what we have learned through the pandemic the new Corporate Centre structure will involve the creation of two new functions at EMT level, from existing functions at the centre: • eHealth and Disruptive Technology function to drive our data and analytics capability and ensure system integration; • A Population Health and Prevention function which will include Test and Trace capability, a key component of public health management.

There will also be a realignment of some corporate activities at the Centre, including: • Within Operations, we will move away from a management structure that has a tendency to reinforce the hospital/ community divide. I am convinced that the changes we are making now will help bring about the integration which we intuitively know is essential to better health outcomes for our population. This is also what Sláintecare envisages.

• Service planning activities is moving under Operations to be closer to services, and to provide clarity for all stakeholders.

• Realignment of teams within HBS to their core functions in the Centre. This will include moving Recruitment into the

The next phase of the programme will focus on building detail into the design of the functions. This will help us to address open questions coming out of Phase 1 and ensure that all activities have a home.

Since the onset of COVID-19, we’ve seen an increased requirement for us to strengthen and resource new functions, such as Procurement, Testing and Tracing, and Public Health. As a result, we have significant recruitment plans approved in Budget 2021 by Government.

We will need more rather than fewer people in the medium term, therefore it isn’t intended to have a voluntary leaving scheme available at this time.

As this next phase of work progresses, you will hear more about the outputs of the programme and how the new structure will impact you and your role.

I want to assure all staff that there are plenty of opportunities for you to contribute your skills, abilities and strengths within the HSE. We will come back to you regularly to give you updates on how things are shaping up.

My vision for the HSE is to enable this way of working by trying as hard as I can to remove as many unnecessary obstacles to the integration of care as I possibly can.

I look forward to your continued support as we further strengthen the HSE and continue to build the trust and confidence of all of our stakeholders.

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Trauma

TRAUMA CARE DURING COVID The new system for planned trauma care can be one of the positive things to come out of the COVID-19 crisis. It will continue to be an integral part of an inclusive trauma system, where a network of facilities and services co-ordinate to provide a consistent high-quality system of care for injured patients across the country, envisioned in the new Trauma Strategy.

T

he COVID-19 crisis put significant pressure on the hospital system and resulted in huge efforts being made across the system to reduce the number of patients presenting to ED and, where possible, to avoid admitting patients to an acute hospital unless absolutely necessary.

The crisis also provided an impetus to develop and test a system for delivering ‘planned trauma care’. Planned trauma care works on the basis that while accidental injuries are not something which can be anticipated, it is possible to plan for their treatment and management.

The objective of planned trauma care during COVID-19 was to keep trauma patients out of an acute hospital setting where possible, while ensuring that they received the highest standard of care in an appropriate facility equipped to deal with their level of injury.

Under the new trauma system, while all major traumas will be treated in Major Trauma Centres, patients with other traumatic injuries will be treated in facilities that can provide the highest standard of care for their level of injury. This means that each patient will receive the right care, at the right time – regardless of their location or the severity of their injury.

Traditionally, people with minor or moderate injuries would present to their local emergency department (ED) for assessment and often x-ray evaluation. The majority of patients could be reassured; some were referred for outpatient management; but a small cohort required in-patient treatment. Where in-patient treatment was necessary, this often meant admission to an acute hospital and surgery.

Injury Units are facilities for the treatment of broken bones,

dislocations, sprains, strains, wounds, scalds and minor burns that are unlikely to need admission to hospital. These facilities provided vital services during COVID-19. Injury units are capable of assessing and treating injured patients much more quickly than might be the case in an ED. The staff are very experienced in treating injuries and in recognising which patients need further intervention.

During the COVID-19 crisis, instant communication systems were put in place so that staff in injury units could liaise with other members of the team. This allowed treatment plans to be put in place quickly and efficiently, often without a patient having to make a second visit to either an ED or an outpatient department.

In cases where a patient required further treatment, such as an operation to treat a broken bone, this could also be arranged.

Arrangements were put in place across the country to enable trauma care to be delivered in a planned way. Hospitals which normally would perform elective surgery, like Cappagh, the South Infirmary in Cork and private hospitals, ceased elective activity and commenced planned trauma care.

This period allowed us to learn some other important things about planned trauma care. Firstly, it demonstrated that a planned trauma care system works. Patients can be initially managed and seen in injury units and it is safe for them to wait until their care can be planned. Secondly, it proved that this was efficient. Many patients were seen and treated in under an hour initially and then had their surgery performed as a day case meaning that the overall impact on their time was minimised.

THREE FRACTURES IN O’MAHONY FAMILY Bad things often happen in threes and that was the case for Tara O’Mahony and her family, who experienced three bone fractures in just six weeks. But Tara had nothing but praise for the staff of South Infirmary Hospital in Cork who she saw plenty of over the Easter break earlier this year, and highlighted the ‘outstanding care’ that they received, first when her daughter broke her arm, then when her older daughter broke her wrist and then finally when her mum suffered a hand fracture.

“The staff in the South Infirmary were absolutely brilliant. The treatment we got was excellent. In fact the whole process was so straightforward and easy, from the break right through to the discharge,” she said. Tara’s four-year-old daughter Bronagh fell off her slide over the Easter weekend and right in the middle of the

COVID-19 pandemic.

“Initially she was seen in A&E and they could see on the x-ray that there was a clean break on the arm and the bones just weren’t lining up. They said that she would need surgery to realign the bones and that she might even need pins put in. So she had a temporary soft cast put on and we were sent home and given an appointment for surgery the next morning in South Infirmary,” she explained. Trauma patients requiring surgery, like Bronagh, are diagnosed in either the Minor Injury Unit or in the Emergency Department and then booked in to hospitals like South Infirmary.

“It was all very straightforward and she was booked in for 6am the following morning. It all went so smoothly and we were in and out so quickly for her follow-up appointments too."

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Trauma

LONG ROAD TO RECOVERY FOR PHILOMENA It has been a long road back to recovery after a broken ankle for Cork woman Philomena Slattery. Philomena fractured her ankle while she was teaching a dance class back in December but a second surgery on the break seems likely as she remains on crutches. “I was teaching a class when I went over on my ankle. I didn’t even fall but I could just hear the crunch of the ankle as it happened,” she explained. After attending Cork University Hospital with the injury in December, she was later transferred to South Infirmary Hospital when it became clear that the ankle would need surgery. South Infirmary

is just one of a number of elective surgery locations that have switched to planned trauma surgeries during the COVID-19 pandemic to ensure patients with minor trauma injuries, such as bone fractures, are dealt with in a timely fashion. “I was transferred to South Infirmary in March because the ankle just wasn’t healing properly and had my first appointment on March 19th. I had been managing my pain levels and hoping the ankle was getting better but the doctors said that it was likely that they would need to operate,” said Philomena. “I had the surgery on May 1st and I was the only person in the place.

The staff were great and I got the very best of care from them. It was all very orderly and a really lovely experience. I didn’t have to wait around for anything. “I’ve been going in every month for check-ups at the clinic and am now checking the ankle myself with an ultrasound machine but I will probably need a second surgery because I am still on the crutches. It’s been a right ongoing saga. I know I was unlucky with the ankle break and everything but I feel relieved that all the treatment and appointments have been so straightforward, particularly because it’s all been happening in the middle of a pandemic.”

MEDICS WERE ‘MIRACLE-WORKERS’ SAYS GRATEFUL DAD 15-year-old Glyn O’Connor walked back through the doors of his secondary school in Waterford on September 29th, a few weeks after his classmates. But it was a delayed trip that his family thought he would never get to make just three months earlier.

Glyn was on a farm in his native Cappoquin early in the summer when he was involved in a freak accident as he was collecting stones from a field and putting them into a tractor-pulled loader.

“I don’t know the exact happenings, but Glyn tripped and fell under the wheels of the loader. They went straight over his body and broke his ribs, pelvis, lower spine and his femur,” explained dad Alan, who added that Glyn’s lungs were also punctured and he was left with horrific internal injuries.

Glyn O’Connor during his stay in the ICU in the Mater Hospital with his dad Alan by his side.

It didn’t look like the youngster was Photo courtesy of the Irish Times. going to live to see the next day, let alone a new school year. to stop the bleeding. The following day, they went back in to fix his “Everything went right for Glyn after the accident. It is a miracle pelvis, lower spine and broken femur. After successive operations, that he is still with us and starting back at school. He really is a case his sedation was eased and he began to wake up. Just five days after study for what the system can achieve when it is working at its best. his horrific accident, Glyn was fully conscious and wiggling his toes.

We could see when Glyn was in the hospital that the system just After three weeks in the ICU and High Dependency Unit in Dublin, doesn’t sleep. His care was seamless, from the second he got onto he was transferred back closer to the family home to Cork University the air ambulance right the way to Cork hospital, up to the Mater and Hospital where he spent the remainder of his time in hospital before back to Cork again. Everyone was on the same page,” said Alan. his discharge.

The youngster was transferred by air ambulance to Cork University Glyn’s walk back to school at Blackwater Community School may Hospital but it didn’t look like Glyn would survive the night. Eventually have been done on crutches, and he will continue to need physiotherapy his condition stabilised and he was transferred to Dublin by ambulance to help him build back up his muscles, but his family remain grateful where Alan and Treasa were introduced to their trauma team of Keith to the trauma teams who gave him a second chance at life.

Synnott and Frank Lyons, who would be operating on Glyn.

“They are miracle-workers. It is because of them that I have my son Glyn then had the first of several surgeries, where medics managed back home with me and able to go back to school,” added Alan.

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Aging

Adult Safeguarding Adult Safeguarding is one of the priorities contained within the HSE Patient Safety Strategy (2019 – 2024).

12,000

NOTIFICATIONS IN 2019 TO HSE SAFEGUARDING TEAMS

28%

FOR ADULTS OVER 65

Cate g o r ies o f abuse

PHYSICAL PSYCHOLOGICAL FINANCIAL

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Aging

The HSE has formally launched an Adult Safeguarding Explainer video and also published the National Safeguarding Office Annual Report 2019. In these challenging times for the health service with the impact of a global pandemic, the publication of the 2019 Annual Report is a timely reminder of the central position that adult safeguarding plays across all health and personal social care services.

This is of particular resonance when we consider the individual stories and experiences behind the activity data and statistics contained in the Annual Report. Working in collaboration with stakeholders and funded agencies, the HSE strives to advance the necessary service improvements in practice, procedures, service provision and care to protect adults at risk of abuse.

It is vital that the business intelligence contained in the Annual Report informs future planning as well as the transition from the current 2014 Safeguarding Vulnerable Persons at Risk of Abuse policy to the revised

2019 HSE Adult Safeguarding Policy.

2019 is the fourth year of the HSE publishing data and recorded outputs on adult safeguarding. This data represents the screenings undertaken

by Designated Officers operating in HSE and HSE funded services as well as direct community referrals to the HSE Safeguarding and Protection Teams (SPTs). The Report also gives an outline of the training figures and programmes undertaken in 2019 which included almost 22,000 participants.

The significant information and messages from the figures are:

• The HSE Safeguarding Teams received almost 12,000 notifications in 2019 and on an average week these Safeguarding teams nationally received over 200 notifications. An additional 1,046 advice calls were responded to by the Safeguarding Teams in 2019 • 72% of notifications related to those 16-64 years, 28% for adults over 65 years of age.

• For persons aged under 65 years the most significant category of alleged

FAIR DEAL EXPLAINED The Nursing Home Support Scheme office has produced three training videos for staff on the Fair Deal Scheme. The videos provide healthcare staff with the knowledge to help in progressing Fair Deal applications for clients. The Fair Deal Scheme – A General Introduction This video will help any staff member who may have contact with clients and families considering submitting a Fair Deal application. It covers the basic elements of the Fair Deal Scheme including frequently asked questions and where to go for further information. The Fair Deal Scheme – Training Presentation Level 2 This video is for hospital and community staff who have significant engagement with clients on their Fair Deal applications.

This video builds on the information provided in the general introduction by providing greater detail on the key elements of the application process. The Fair Deal Scheme – Ancillary State Support This presentation will help healthcare staff who have significant engagement with clients applying for Ancillary State Support, known as the Nursing Home Loan. It describes the process from start to end, including who can apply for ASS, further deferral of the loan and the recoupment processes.

The videos are on HSELand. Search ‘Fair Deal’ in the Discovery Zone in the Hubs section. Can we get a link to this please

FOR MORE INFORMATION:

www.hse.ie/safeguarding

An online copy of the 2019 Annual Report can be accessed which also contains information on contacting Safeguarding and Protection teams.

abuse is physical abuse followed by psychological abuse • For persons aged over 65 the most significant categories of alleged abuse are psychological abuse ,physical abuse and financial abuse • Alleged financial abuse and neglect increase with age with the highest level of reporting in those over 80 years The report highlighted need for on-going investment and pressing requirement for legislative reforms in the area of adult safeguarding The recently launched adult safeguarding explainer video is an accompaniment to a HSE Safeguarding training programme and can be used by the wider public as a user friendly account of how to recognise and respond to adult abuse concerns.

Tim Hanly, General Manager of HSE National Safeguarding Office, said, “The publication of the National Safeguarding Office Report 2019 and the launch of this video indicate once again the important role of adult safeguarding especially at this time of such uncertainty for adults who may be vulnerable and at risk of abuse. In the past four years, this service has provided an intervention and oversight role in over 40,000 safeguarding concerns. Interagency collaboration and associated public awareness are central in the protection of adults at risk of abuse in Irish society. The HSE is committed to implementing a revised and updated Adult Safeguarding Policy during 2021 as a core part of the organisation’s service improvement plans.”

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Development

TALKING FINANCE Due to the COVID-19 pandemic, the timeline has been revised for Integrated Finance Management System (IFMS), the project to introduce a single national integrated financial management and procurement system (SAP S/4 HANA) across the health sector.

In March, the focus for the IFMS Project moved to fast-tracking a new national procurement system, SAP Ariba Snap. SAP Ariba is part of the original project scope but was accelerated as a direct response to the pandemic. This was to ensure security of supply to all health facilities for valued frontline staff and the supply base during COVID-19 and beyond.

Buyers can access it safely and easily on the internet from anywhere, on a laptop or through a mobile app. Browsing and ordering goods and services from the HSE’s top suppliers is straightforward, like shopping online. There are now more than 70,000 items available to buy on the

system, from over 130 suppliers. Enquiries on how to get set up on SAP Ariba can be submitted by emailing ariba.helpdesk@hse.ie or by calling 0818 500999.

At present, the IFMS Project team is completing detailed design of the system to meet requirements across the health sector. This involves workshops taking place online with colleagues from across the statutory, Section 38 and Section 39 organisations who will use the system. This is an opportunity for stakeholders to see the national IFMS design before it’s built.

The IFMS Project team would like to thank everyone who has been involved in the project to date and looks forward to working with others in the future. With IFMS, the health sector will move to one system, with modern technology and streamlined processes. This will enable better informed decisions, benefitting patients, services and the public.

You can watch a short video about IFMS at hse.ie/hse-finance (username hse-finance, password: f1nanc3)

Rev i s e d t i me l i ne fo r IFM S The IFMS Project team has now returned focus to the design stage of IFMS and has completed re-planning for the project, led by the systems integrator DXC Technology. This exercise took into account the past, present and potential future impacts of COVID-19 on services and stakeholders.

The new timeline, encompassing the design, build and Phase 1 deployment of IFMS, has been approved by the IFMS Steering Committee.

Design Completion

February 2021

Build and Test Completion

August 2021

Deployment Group A Go-Live (HSE East, National Distribution Centre and Tusla)

April 2022

Deployment Group B Go-Live (Mater Hospital and St. Michael’s House)

August 2022

Deployment Group C Go-Live (HSE West and Western Care Association)

January 2023

Deployment Group D Go-Live (HSE South and HSE South East)

July 2023

PHOTOGRAPHY A T H E R A P E U T I C AC T I V I T Y

An online photography and art exhibition open to submissions from service users, family and staff across the service areas and community partners and hosted by the Mental Health Service team was successfully hosted online for Mental Health Week 2020 in Dublin North City and County.

The theme for the exhibition was ‘My Recovery’ and participants were asked to share up to three photographs with a brief explanation as to why the images have meaning to them.

Ruth Power, Service Improvement Manager, Community North City & County Mental Health Service (CHO DNCC), was involved in organising this.

“Photography, as with other creative activities, is used as a therapeutic activity in a number of settings and the reasons for this are easy to see. Its many benefits include helping to develop skills in relation to concentration, problem solving, self-confidence and self-expression,” said Ruth.

“With COVID-19 restrictions in place, opportunities to participate in community activities are limited.

Many people who experience mental health difficulties also experience social isolation, something mental health staff work with service users to overcome by creating opportunities to develop skills which enable full community citizenship. Ideally, an art exhibition would provide opportunities for just this – to meet other people face to face and share the experience. We have had to be creative this year in how we do this and so, people have been supported to access the online exhibition and share their experience with each other in this way.”

The online exhibition launch was hosted

by Kevin Keane of the Service Improvement Recovery and Reform (SIRR) project team via WebEx, where guests were taken on a virtual walkthrough of all submissions and in some cases a number of photographers spoke about their own work and experiences.

Altogether 65 people submitted 130 photography and paintings. These were uploaded to online virtual galleries that were easily viewed and navigated on a PC or smartphone.

All participants receive a PDF of the exhibition containing the work of all involved.

Angela Walsh, Head of Mental Health complimented the initiative, saying, “During these times, using online resources like this gallery, provides people with an opportunity to be creative and share their work with a wider audience. I’m so grateful to the team and all those who submitted photography and paintings, this was an incredibly positive event for everyone involved.”

The SIRR team have subsequently received positive feedback back on the initiative and it is hoped that the event will be a regular feature of the Mental Health Week in the future.

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Tech

TALKING TECH WHAT DOES GDPR MEAN FOR YOU? COVID-19: Remote Working and Data Protection Considerations The COVID-19 pandemic has a significant impact on the way we live our day to day lives. In particular, reducing our level of contacts with others and restricting our movement has led to innovative ways to interact with our patients and service users. We now have a greater reliance on telemedicine and have introduced new ways of working for our staff with an increase in the number of people working from home.

The General Data Protection Regulation (GDPR) in place since May 2018 puts greater obligations on those who collect, process and store personal data such as HSE and also give greater safeguards and rights to individual’s whose personal and sensitive health data we are entrusted with.

While data protection does not inhibit the HSE from taking the necessary steps to manage public health in times of crisis, our legal obligations to act in a reasonable manner and to continue to take the necessary steps to protect personal data remain as strong as ever.

HSE has developed a policy for staff working from home and this, along with a comprehensive suite of guidance for their managers, can be accessed via HSE.ie website. It is important to note that HSE policies continue to apply to staff when working from home on the same basis as they do under traditional office working arrangements.

FIND OUT MORE ABOUT GDPR: WWW.HSE.IE/ ENG/GDPR/

Unless deemed necessary, paperbased files containing personal information of clients should not be taken home. If your manager has carried out the required risk assessment and deemed it necessary for you to have such files at home, then you need to be vigilant to ensure that all information is kept confidential and secure and that only the minimal amount of personal data required is removed from HSE premises. A tracer system should be in place to track where the files are at all times and files should be returned to the HSE at the earliest possible opportunity.

Normal ICT policies and procedures continue to apply when working from home. You should only use HSE computers and devices which have appropriate security features built-in. You should never use your private e-mail address to send and receive HSE communications.

The importance of ensuring social distancing during the pandemic is well understood.

To facilitate this, the HSE has introduced solutions to allow clinical consultations take place remotely using videoconferencing. Details of these applications and guidance around their use can be found on HSE.ie.

While the vast majority of the HSE’s data processing activities are safe and secure, despite the best efforts of our staff, things go wrong occasionally and data is shared inappropriately. In those situations, the most important thing is to act swiftly to take the necessary steps to correct the error and to enable us to prevent similar issues arising in the future.

The GDPR section of HSE website provides the necessary guidance for staff to report and manage data breaches.

Ta lk to J im The HSE has appointed Jim O’Sullivan as its Data Protection Officer and he, along with colleagues in the regional Consumer Affairs Offices will be glad to offer any advice and support that you may require in relation to data protection.

Jim can be contacted at Room 102, Phoenix Hall, St Marys Campus, D20 CK33, Phone: 087 9082 160, email: dpo@hse.ie

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Allergies

Six-week allergy initiative reduces CHI wait list by 474

C

TOP: Prof Jonathan Hourihane, consultant paediatrician at CHI at Temple Street; Eilish Hardiman, Chief Executive, Children’s Health Ireland; Sonja Medan (10); and Dr Mohammed Tariq, consultant paediatrician, Midland Regional Hospital Portlaoise MIDDLE: Prof Jonathan Hourihane and Declan Sharkey with his 11-year-old son Ryan Sharkey from Donegal. BOTTOM LEFT: Dr Mohammed Tariq with Sonja Medan (10) and her mum. BOTTOM RIGHT: Dr Byrne, consultant allergist

CHILDREN ATTENDED THE FOOD CHALLENGE CLINIC HELD IN CITYWEST

hildren’s Health Ireland (CHI) have experienced similar challenges to all hospitals during the current climate of living with COVID-19 in terms of sufficient space to manage patient throughput in its hospitals as they adhere to the public health measures on social distancing and infection prevention and control. CHI Allergy Team identified a unique opportunity to vastly reduce the current day case waiting list for patients requiring food challenges. The use of the CityWest facility with the support of the HSE allowed for a focused period to manage a high volume of patients over the course of four days a week over a six-week period which began in September. During this period 474 children attended the Food Challenge Clinic. At the time of go-live, CHI had over 700 patients on their clinical immunology waiting list for drug and food challenges.

Whilst restrictions existed pre-COVID in terms of access to day ward availability for these patients, this was compounded by the current guidelines in place which require a reduction in patient throughput on our acute hospital sites. Families whose children aged 2 to 18 years had been on waiting lists, some for up to four years, at CHI at Crumlin, Tallaght, Cork University Hospital and Temple Street, were invited to attend for their food challenge. Dr Byrne, Consultant Allergist CHI, explained that each of these families would had previously attended an allergy/general paediatric outpatient clinic at CHI, at which time an oral food challenge was advised for their child. Prof Jonathan Hourihane, Consultant Paediatrician at CHI at Temple Street, said, “At their hospital clinics, paediatricians who specialise in allergy can usually only carry out about four food challenges a week. We’ve had the capacity to see approximately 27 children each day.” The general feedback from patients and their families has been extremely positive. Parents have been very impressed with the facility and delighted to have this opportunity to complete the food challenges for our patients, a number of whom were waiting since 2017 and 2018.

Further information is available on: www.ifan.ie

NOTE: IMAGES WERE TAKEN IN BEFORE LEVEL 5 RESTRICTIONS WERE IN PLACE. PHOTOCALL PARTICIPANTS ALL ADHERED TO GUIDELINES FOR SOCIAL DISTANCING. JULIEN BEHAL PHOTOGRAPHY

FOOD CHALLENGE CLINIC SUCCESS

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Research

SPOTLIGHT ON

GLOBAL HEALTH

D r Mike Rya n

COVID-19 has forced us to recognise the global nature of health, reports Dr Treasa Kelleher.

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he Global Health Education Ireland Symposium 2020 was held virtually to resounding success recently. This symposium facilitated by the Forum of Irish Postgraduate Medical Training Bodies provided a unique and exciting opportunity for HSE staff and others to engage with and learn about current developments in global health from the world’s eminent experts. In the current climate of a worldwide pandemic, international efforts to combat COVID-19 bring the global nature of health into sharp focus – we face this global threat together.

United we stand, divided we fall. The theme of this year’s symposium was ‘Learning from COVID-19 and improving health for all’ with an additional focus on education in global health.

Colm Brophy TD, Minister of State for Overseas Development and Diaspora, thanked healthcare staff and reported being “struck by the professionalism, dedication, hard work and resilience of our health

workers as we learn to navigate a pandemic”.

He outlined how Ireland must invest in better global health outcomes and described the ongoing commitment of the Irish government to achieving “gender equality, reducing humanitarian need, addressing climate action, and improving governance”. Minister Brophy also announced a new partnership between Irish Aid and the HSE to support the mental health of healthcare workers in Ethiopia and Jordan.

Other highlights from the first session of the symposium included a presentation from Dr Colm Henry, Chief Clinical Officer of the HSE. Dr Henry stated that COVID-19 has starkly “reminded us of the globalisation of health and forces us to recognise the transnational nature of health issues, determinants and solutions”. He stressed the importance of taking a whole government approach to combating COVID-19, strong surveillance and response systems, effective engagement with local communities and

making efficient use of resources.

Dr Mike Ryan, Executive Director of the Health Emergencies Programme, WHO, was another highly anticipated speaker at this symposium. He did not disappoint. Dr Ryan spoke about the future of global health training. He explained how the world has changed in relation to education in health and how COVID-19 has revealed “existing fragilities, inequities, lack of flexibility and lack of scalability” within health systems.

He outlined some of the current challenges that we face as healthcare staff, such as the shortfall of at least 18 million health workers worldwide and the need for health systems that are prepared and can scale up rapidly in response to emerging health threats.

He advised that we must all learn to care for our own mental health in the face of the increased work stresses encountered at this time and emphasised the importance that all health workers have access to the “support services that they need” at this time.

REPLAY If you missed the symposium and wish to view any of these presentations yourself, they are available on the RCSI’s YouTube channel

Dr Treasa Kelleher, Specialist Registrar in Public Health Medicine, HSE Global Health Programme

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Development

TUH opens state-ofthe-art renal unit NEW KILMALLOCK PRIMARY CARE CENTRE

Annamma Samuel, CNM2 Home Therapies, with Professor George Mellotte, Consultant Nephrologist and HSE National Nephrology Lead, in the new reception area where patients will arrive when they attend for Dialysis in the new Vartry Renal Unit at TUH.

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he Renal Team at TUH have delivered the first sessions of life-preserving dialysis in the new Varty Unit. The unit is called after the reservoir in Wicklow where the water supply for the dialysis service is sourced. TUH supervises over 30,000 haemodialysis sessions a year.

TUH is the second largest centre in the country for haemodialysis management. As the numbers of patients requiring this essential treatment increased, the provision of this treatment in the current 12 bed unit was no longer suitable. The Varty Unit will provide a patientcentred environment with larger capacity, a Home Therapies Unit and a self-care Haemodialysis Unit. The 2,700m2 Unit built over two floors has 28 Haemodialysis Treatment Bays, six single haemodialysis rooms for immunocompromised / acutely ill patients, four home dialysis training (peritoneal and haemodialysis) rooms and for the first time in Ireland, four self-care haemodialysis bays. There are also 14 offices which for the first time will bring all the different medical and allied health care professionals that are involved in the care of renal patients together.

Speaking on behalf of the Renal team at TUH, Professor George Mellotte, Consultant Nephrologist and HSE

National Clinical Lead in Nephrology, said, “This is a landmark day for the patient care in TUH and could not have come at a better time as Ireland has seen a 3% increase in the number of patients requiring dialysis every year for the last 10 years. Following the arrival of COVID-19, there has been an increase in dialysis patient numbers nationally by 6%. I and the Renal Team are looking forward to caring for our patients in this new state of the art facility. Our patients attend for dialysis three times a week for up to four hours at a time, some have attended for over 1,000 sessions. I have no doubt our patients receiving their life-saving treatment in this brighter modern facility will be of great comfort to them.”

Funding for the building of the unit was provided by the HSE and is one of the Government’s National Development Plan projects 2018-2027 and Dublin Midlands Hospital Group.

You can take a virual tour of the new unit via this link. https://www.youtube.com/ watch?v=af1StrAT2mE&feature=youtu.be

The people of Kilmallock, Co Limerick and its surrounding areas are now benefitting from having a fantastic facility on their doorstep, in the shape of Kilmallock Primary Care Centre.

HSE Mid West Community Healthcare’s newest Primary Care Centre, which opened at the end of August, is bringing a range of Primary Care Services to a population of 6,380 people in Kilmallock, Ardpatrick, Ballymacshaneboy, Bruree, Dromin and Athlacca.

These include public health nursing, speech andl therapy, occupational therapy, physiotherapy, podiatry, primary care social work services and primary care dental services.

The facility, which has a pharmacy on site, also accommodates the services of Dr Sonya Ryan and Dr Elizabeth Murphy, while also supporting patients of other GPs in the area.

The two-storey building is 1,610 square metres and provides 65 surface car parking spaces.

The building houses 16 core staff from primary care and a further 4 staff operating support services as a network resource from the facility. The centre has a range of clinical, interview and bookable rooms to deliver a wide range of services. The facilities have been developed to meet the highest infection control, safety and energy standards in a bright and modern environment.

This dynamic new centre will enable multi-disciplinary services to be delivered on a single site. It will support closer coordination between Health Care Professionals and will also enhance ease of access for the public.

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Lifestyle

Better Ageing

Introducing the first Age Friendly Primary Care Centre in Ireland AGE FRIENDLY DESIGN From the outset, it became apparent that that by integrating the various design initiatives from the beginning, the age friendly aspects of the building could be achieved at little or no extra cost to the project. Items incorporated into the design included: (1) An improved public realm with age friendly designated parking spaces, set-down area, sheltered areas, landscaping and age friendly seating. (2) A specific colour scheme throughout the building along with a signage design that incorporated the use of symbols and contrast as much as possible.

(3) Public doors were coloured

The first Age Friendly Primary Care Centre in Ireland became operational at Athy Primary Care Centre (PCC) during summer 2020. This centre was developed through the HSE’s Operational Lease mechanism which facilitates primary care services being provided by both the public and private sector (HSE and General Practitioners) on an integrated basis.

The town of Athy was selected by Kildare County Council as an Age Friendly Town in 2020 with a number of initiatives rolled out across the town. The programme aims to work within existing community structures, networks and service providers in order to make Kildare a great county in which to grow old. As part of the initiative, Kildare County Council reached out to the HSE to work with them on making Athy PCC the first Age Friendly centre in the country. A working group from HSE Estates, Primary Care Services and both Kildare and Wicklow County

Council was set up to identify what elements could be incorporated into the design of the centre to ensure it would be Age Friendly.

As there were no specific guidelines to adhere to, input from all members of the group was required to come up with an action plan for the centre. The team drew on all available literature, including The Centre for Excellence in Universal Design publications, WHO guidelines on Age-Friendly Cities and Primary Care Centres and other projects HSE Estates had been involved in to date which catered for patients with dementia. Primary Health Properties (the developer) and their team from Axis Group and Quinn Architects engaged enthusiastically with the age-friendly proposal and worked closely with HSE Estates to incorporate the recommendations.

One of the recommendations was that familiar images of the locality be utilised in the finishes in the centre, and

coded and contrasted with the wall colours, any doors leading to store rooms or staff areas were blended in with the colour scheme so they were not as visible to the public.

(4) Access systems were set up to facilitate easy access to the building above that required by the Building Regulations. (5) Furniture selected for the building was on the basis they would be age friendly

a series of photographs of Athy were commissioned from local photographer, Robert Redmond, who sadly passed away shortly after the photographs were taken. His last images of Athy now adorn the walls in the centre providing a familiar reference point for service users attending the premises.

The soon to be completed Baltinglass Primary Care Centre will also incorporate the Age Friendly design elements, as will other centres currently in construction nearby in Arklow and Rathdrum.

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Development

Modern and welcoming new addition Sligo Leitrim Mental Health Services are now operating the new Adult Mental Health Unit on the grounds of Sligo University Hospital.

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his exceptional modern and welcoming unit, built at a cost of €13.8 million, includes 25 single ensuite bedrooms, ensuring privacy and dignity of residents alongside family and child visiting rooms, and communal areas offering social connection, a relaxation suite, beauty treatment room and state-of-the-art occupational facilities in additional to a beautiful outside courtyard with games tables for recreation.

The opening of the new unit both marks the end of an era in mental health service delivery in Sligo with the closure of the old St Columba’s hospital in October and a new beginning as we move closer to the provision of a modern mental healthcare infrastructure and service for the people of Sligo and Leitrim.

The building, with healing and stabilisation at the core, has been co-designed and built with those who access mental health services, listening to and responding to their requests and underpinned by a recovery approach.

In order to implement national policy objectives contained in Healthy Ireland, Tobacco Free Ireland and the HSE Tobacco Free Ireland Programme, and to protect staff,

service users and visitors from the harmful effects of tobacco smoke, the new Adult Mental Health Unit has adopted a Tobacco Free Campus Policy.

The mental health services will continue to endeavour to ensure that those accessing services will receive the same high quality of care and support through their sevendays-a-week enhanced community mental health teams in Markievicz House Sligo, The Rock Ballymote, Manorhamilton Primary and Mental Health Care Unit and Summerhill Lodge in Carrick on Shannon.

These hubs are staffed seven days a week and are in a position to offer assessments to people with mental health problems daily.

Speaking about the new unit, one service user commented, “This new beautiful spacious light-filled building is a vast improvement on where treatment was offered in the past. As someone with lived experience of in-patient treatment and the old unit, I am delighted to see people will now be afforded the dignity and respect they are entitled to with regard to where they are staying.

"It’s a huge step forward: this is a wonderful facility, conducive to recovery and no more than people deserve.”

One patient's family member added,

“When I arrived at the new unit I felt very optimistic. As a family member, I saw the new unit as the perfect environment to offer a recovery focused service. I also felt that anyone who might need to use this unit would be happy for their friends and family to visit. All these things help the service user maintain connections and lead to a more speedy recovery.”

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Development GREEN FLAG FOR SLIGO HOSPITAL Sligo University Hospital (SUH) was awarded the prestigious Green Flag award and becomes only the second hospital in the country to attain the award from An Taisce and the Foundation of Environmental Education (FEE).

The internationally recognised ‘Green Flag’ award is the result of four years of hard work and commitment of a number of stakeholders (SUH management and its staff, HSE Estates, National University of Ireland Galway (NUIG) Medical Academy and the SUH Green Campus Committee). The group took on the seven-step Green Campus Programme to develop the hospital as a healthcare facility that delivers high quality care, improved public health and wellbeing without exhausting natural resources or causing ecological damage.

Improvements in environmental management resulted in reducing energy, waste and increasing recycling levels.

S o m e o f t h e h ig h lig ht s in c lu d e • Reducing energy consumption by 18% since 2016, whilst patient activity increased by 7.9% • Reducing food waste by 6.4% through staff training and protected meal times for patients • Incorporating Sustainability into the Medical Students curriculum by running a Green Campus workshop in conjunction with NUIG • Reducing single use plastic cups by purchasing delph alternatives • Successful partnerships with IT Sligo and the HSE National Health Sustainability Office (NHSO) in organising a Sustainability Seminar for both staff and students from each organisation and the wider sustainability community • Working closely with Healthy Ireland by linking health awareness to sustainability with the establishment of walking routes around the hospital grounds and surrounds Grainne McCann, Hospital Manager said, “Here in Sligo University Hospital we are adopting a multi-faceted approach to address sustainability issues, while maintaining a healthy, green and comfortable environment for patients and staff. We are committed to delivering environmentally responsible quality healthcare into the future by developing staff, patient and public awareness of sustainability issues.

We have a very active Green Campus Committee; however, it is only with the support of all the staff in the hospital and indeed our patients and visitors too, that we are able to make an impact. We are delighted to be awarded the Green Flag in recognition of the efforts of all involved and to keep us motivated on our sustainability journey.”

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Mental Health

Social Prescribing

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he purpose of the webinar was to launch an evaluability assessment and minimum outcomes evaluation framework report for social prescribing in Ireland, commissioned

by HSE H&W and NOSP. The launch of the minimum outcomes framework represents a very important step in building the evidence base for social prescribing in Ireland. Social prescribing is a means of enabling GPs, nurses and other health professionals to refer people to a range of local, non-clinical services provided by the voluntary and community sector. A social prescribing scheme generally has three key components – 1) A referral from a healthcare professional, 2) A consultation with a link worker and 3) An agreed referral to a local

HSE Health and Wellbeing (H&W) and the National Office for Suicide Prevention (NOSP) hosted a webinar entitled ‘Social Prescribing in Ireland: Building the Evidence Base’ in September. community activity. Examples include art, cookery, meditation, GAA, men’s sheds, music, drama, walking groups and many more. There was huge interest in the webinar and 497 people registered to participate on the day.

The audience included social prescribing link workers, HSE staff across a range of disciplines, researchers and academic agencies and funders of social prescribing including HSE, Department of Health and other government and nongovernmental organisations

CATCH UP The Mental Health & Wellbeing programme HSE has convened an oversight group who will be looking at how social prescribing can be mainstreamed and embedded into health service delivery at community health network level. This evaluation framework is a very important first step in the process of ensuring what works with regard to social prescribing.

A copy of the report and a recording of the webinar is accessible here https://www.hse.ie/eng/services/list/4/mental-health-services/connectingfor-life/publications/social-prescribing-evaluability-assessment.html

O n t h e d ay The webinar was chaired by ANNE SHERIDAN, Programme manager for Mental Health and Wellbeing, HSE Health & Wellbeing and included inputs from: • Dr Stephanie O’ Keefe, National Director, Strategic Planning & Transformation in the HSE • Dr Michael Dixon (NHS Clinical Lead for Social Prescribing) • Minister Frank Feighan, Minister of State with responsibility for Public Health, Wellbeing and National Drugs Strategy • The research team who completed the research (S3 Solutions & Elemental) • A panel of experts who are engaged in Social prescribing work.

A vibrant panel discussion took place which covered topics such as the impact of Covid 19 on social prescribing services and evaluation of social prescribing, the challenges of digital poverty and next steps with regard to implementation of the recommendations in the report.

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Mental Health

SAVE A LIFE

NEW PROGRAMME

Learn a lifesaving skill in 90 minutes

Staying Connected

M

ost people are surprised to learn that by asking someone if they are TO FIND MORE thinking about suicide and listening INFORMATION to the response, they could help ON OUR SUITE save a life. Suicide prevention OF FREE SUICIDE training provides people with the lifesaving skills to PREVENTION help a family member, friend, colleague, patient or even TRAINING a stranger they meet on the street. In 2019 alone over PROGRAMMES, VISIT 15,000 people attended a range of free suicide NOSP/TRAINING.IE prevention training programmes across Ireland.

Suicide is a complex problem and addressing suicidal behaviour means supporting people in many different ways. Suicide prevention training has been identified as one of the key evidence informed suicide prevention strategies in Connecting for Life (CfL), Ireland’s National Strategy to Prevent Suicide.

When people are thinking about suicide, they can send out invitations for help, suicide prevention training helps participants become alert to those invitations.

It is important to remember:

• When someone is thinking of taking their own life, it is frightening for everyone involved.

• You might find it hard to understand what they are going through.

• You may feel uncertain as to how you can help.

• Suicide prevention training provides you with the skills and confidence to connect ‘at-risk’ individuals with lifesaving resources.

What happens at suicide prevention training?

At any of the suicide prevention training programmes offered by the HSE National Office for Suicide Prevention (NOSP) participants can expect to feel challenged, empowered and hopeful. You will learn the importance of suicide alertness and identify people who have thoughts of suicide. You will learn clear and practical information on what to do if you need to support someone who is at risk of suicide. You will learn and practice the steps to connect a person with suicidal thoughts to first aid help and further community resources.

How can I get involved?

NOSP has launched a new 90-minute online suicide prevention training programme, Livingworks Start. This introductory suicide prevention training provides you with an interactive experience which will give you the skills and knowledge to keep others safe from suicide. The programme is suitable for anyone over the age of 18 who wants to help prevent suicide and is prepared to become more suicide alert.

How does Livingworks Start work?

You can complete the programme on any device or computer. Once you have activated your free licence you can log in and begin the programme, which uses a mix of content, video and interactive questions. On average it will take 90 minutes to complete but you can work at your own pace.

Pre-post test analysis indicates that LivingWorks Start:

1 2 3

Significantly increased participants’ confidence in identifying appropriate services that individuals in distress could be referred on to.

Significantly increased participants’ confidence in dealing with the needs of someone who may be suicidal.

Led to significant positive improvements in participants’ attitudes towards suicide prevention.

The team working at St Joseph’s Mental Health Intellectual Disabilities Services saw how difficult it was for residents and families who were unable to have physical visits with their families or friends due to restrictions during the COVID-19 pandemic and wanted to do something about it.

Dr Michael Tully , senior psychologist within the service, explained, “At the beginning and throughout COVID-19 lockdown, the ability for our residents to engage in the community and see friends and family has been significantly reduced, making this a very difficult and challenging time for them. The team at St Joseph’s Mental Health and Intellectual Disability service sourced funding so that each residential unit would receive a tablet and Wi-Fi access, which meant they could stay in contact and see family and friends, as well as engaging with one and other through online recreational groups. A number of Departments worked together to make this a success and the outcome has been of real benefit to our residents.”

The impact has been significant, from one resident who was thrilled to see his brother in Australia on his 51st birthday.

This initiative has provided residents with a new means of communication that they can initiate themselves. The importance of maintaining relationships is clear to promoting health and wellbeing.

The Head of Service, Mental Health Community Health Organisation Dublin North City and County, Angela Walsh, said, “Feedback from residents has been extremely positive saying that some have expressed a growing interest in this new technology and how to use it. For most residents it was their first experience of face to face video call.

We really welcome the initiative of the team at St Joseph’s Mental Health and Intellectual Disability service in ensuring residents can stay in touch with loved ones during this time.”

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Innovation

RISE OF THE ROBOTS Introducing Robotic Process Automation (RPA) to the health sector

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he HSE is continually changing as it reacts to the health needs of society, the most recent instance being the response to the COVID-19 pandemic.

While it is imperative that our frontline health and social care functions can adapt, it is also critical that our supporting services can respond quickly within this changing environment.

A new and innovative shared service offering has recently been established for the public health sector – the Robotic Process Automation (RPA) Centre of Excellence. RPA is a computer software that allows staff to transfer repetitive and administrative elements of their work to virtual assistants, releasing time back to health staff to focus on higher value activities.

Julie Ryan, Assistant National Director, HBS Business Excellence & Digital Innovation, who is leading out on this new service offering, said, “Continuous improvement and automation remains firmly within the strategic agenda. We have seen that the pandemic has accelerated digital transformation and therefore it is more important than ever before to be agile on maximising the impact and benefits of RPA.” One of the responsibilities of the HR National Personnel Records (NPR) team is to update employee records on the SAP HR system with Garda vetting outcomes provided by the HSE’s Garda Vetting Liaison Office. While this is a relatively straightforward task, it is time-consuming and requires at least two people working full time to complete the process each month. Adding to an already high caseload, a recent directive where staff in relevant roles must be re-vetted every three years, as well as increased recruitment due to the COVID-19 pandemic, was expected to increase the team’s workload by 300%.

To help manage this increased caseload, NPR worked with the RPA Centre of Excellence over a 10-week period to train up a new team member - Bertie. Bertie is a software robot that is able to take the list of completed garda vetting results, search for employees on the system and update their personnel profiles in SAP. Where Bertie cannot find a person on the system, another member of the NPR team steps in to investigate, providing quality assurance where human judgement is needed.

Having Bertie on the team has been a significant help to NPR. Before Bertie, the team had to manually search and update over 20,000 personnel records a year. Bertie is able to work through the night processing at a speed of 11 seconds per case, where previously it took the team 9.5 minutes. Thanks to the robotics initiative, vetting results are now updated weekly instead of monthly, reducing the time taken to get new appointments into frontline posts. Additionally, the team will now be able to absorb the expected 60,000 cases a year and are using the time released to manage their database and resolve data quality issues that Bertie identifies.

Wh at 's n ext ?

The RPA Centre of Excellence will be working with all areas of the public health sector over the coming months to identify further opportunities for RPA across the health sector.

To find out more about RPA please email rpa@hse.ie

TECHNOLOGY & DIABETES The Paediatric Diabetes Service at Portiuncula University Hospital (PUH) has changed the way it delivers outpatient appointments and follow-up support to families and children living with diabetes.

Roisin Meleady, Paediatric Diabetes Nurse at PUH explained that the Paediatric Diabetes Service provides outpatient care to children and adolescents under the age of 18 living with Type 1 and Type 2 Diabetes.

“Using the ‘Attend Anywhere’ video platform we hold virtual appointments every week and try to be as flexible as possible to fit in with the families’ busy schedules. No special or high tech screen is needed as this service is accessible securely via a smart phone,” she said.

“There has been positive feedback from families who have used this service. It also allows us to discuss the data which patients have remotely uploaded from their devices such as insulin pumps, continuous glucose monitoring systems and their blood glucose meters.

“We are also able to teach patients/ families how to use continuous glucose monitoring systems so that they can start using these technologies. We can discuss carboyhdrate counting and setting up ratios allowing for better glycemic control. This has probably been the most valuable and beneficial change as previously these educational clinics were held in the hospital.

“Our aim is to continue to deliver a quality and responsive diabetes service that optimises health and wellbeing for children, young people and their families during this difficult time.”

One parent of a 14-year-old patient commented, “The platform is easy to use and access. I was able to connect from work and it was great not having to take a day off but still being able to get help and advice when needed.”

Roisin Meleady, Paediatric Diabetes nurse at Portiuncula University Hospital, who has been delivering virtual outpatient appointments for patients and their families

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Innovation

VIRTUAL CLINIC

NEW PROGRAMME

Virtual orthopaedic clinic in Galway sees 1000 patients in first 10 weeks

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new virtual orthopaedic clinic in Merlin Park University Hospital saw 1,000 patients within the first 10 weeks of operation. The consultant-led clinic replaces face-toface appointments for patients with fractures that don’t require surgery.

Odhrán Murray, consultant orthopaedic surgeon and virtual clinic lead said, “We had started looking at making changes to the way we run our outpatient fracture clinics at the start of the year, to identify ways to make the patient experience easier by reducing travel to appointments.

“The pandemic added an urgency to our plans. In a very short space of time we needed to change our practice in order to reduce the numbers attending appointments for social distancing reasons and to keep our patients and staff safe.

“We planned the introduction of the virtual clinic very carefully. In our outpatient clinics we see patients from all over Co Galway along with patients from Ballinasloe, Roscommon and Ennis hospitals. This meant that in addition to changing our way of working, we had to introduce the changes to our colleagues in the other hospitals also.”

Traditionally patients with a broken bone went to the Emergency Department or Injury Unit to have a temporary cast applied and the following day attended the fracture clinic. “Now patients who don’t need to be admitted for surgery or other complex cases, have a splint applied where possible when they first visit the hospital. The following day, myself or one of my consultant colleagues review their case in a virtual clinic with nursing and physiotherapy input. Following the consultant review all patients are contacted directly by the physiotherapist or nursing team to discuss their care plan,” said Odhrán.

“In this way, 50% of our patients are managed without needing to attend the orthopaedic outpatient clinic.”

Sharon O’Connor, Clinical Specialist Physiotherapist in the virtual clinics, added, “We have worked with our colleagues in IT to develop systems that allow us to automatically generate letters to the patients’ GPs and these are emailed to GPs directly from clinic. This saves time previously spent on dictating, typing, printing and posting letters. GPs are updated immediately on their patients’ care rather than waiting for the post. The new system also lets us audit our activity at the touch of a button which saves us the hours that we would have spent pulling notes in the past.”

Galway University Hospitals’ Orthopaedic Department staff involved in developing a Virtual Orthopaedic Clinic which saw 1000 patients in the first 10 weeks. From left: Mr Fintan Shannon, consultant orthopaedic surgeon; Mr Odhrán Murray, consultant orthopaedic surgeon and virtual clinic lead; Peter O’Reilly, Evolve developer, IS Department; Sharon O’Connor, cinical specialist physiotherapist; Mary Fanning; and Fionnuala Heverin.

Donors Invest €2m to deliver robotic surgery to Tallaght University Hospital Tallaght University Hospital have completed their first robot assisted surgery thanks to a €2m investment by Tallaght University Hospital Foundation. The patient has been successfully discharged home.

The newly delivered da Vinci Surgical System enables surgeons to perform complex minimally invasive surgical procedures with precision and accuracy. Christened ‘Leona’ by staff, the robot allows surgeons to operate at high levels of precision without ever touching their patients. It will mean smaller incisions, less pain, reduced blood loss and a quicker recovery time for the patient.

The first successfully completed surgery was a radical prostatectomy performed by robotically trained consultant urologist Mr Arun Thomas.

Commenting on the surgery Prof Paul Ridgway, consultant surgeon and perioperative clinical director at TUH, said, “Completing the first robotic assisted surgeries at TUH is a significant milestone in our continuous efforts to push the boundaries of the provision of healthcare to our patients. We are fortunate at TUH to have several robotically trained surgeons and nurses on staff so we were able to get Leona working almost immediately on her arrival. Leona’s arrival is a major step forward in driving innovation at TUH and providing our patients with cutting edge technology to ensure the best outcomes from their surgery.”

TUH has a strong tradition of developing minimally invasive surgical techniques and pioneering Irish short stay and day case minimally invasive surgery, particularly in the areas of urology, general surgery and orthopaedics. Initially Leona will be used primarily by the busy Urology service at TUH, with colorectal surgery and gynaecology also using the new robotic system in time.

Pictured from left to right in Theatre 12 at TUH as Leona arrived were Angela Clayton-Lea, Perioperative Directorate Operations Manager; Douglas Collins, CEO TUHF; Mr Arun Thomas, Consultant Urologist; Isam Odwan, CNM1 in GU theatre; and Lucy Nugent, Chief Executive of TUH.

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Programmes RAPID RESPONSE RESPIRATORY SERVICE

LEFT: Steering Committee, left to right: Emma McGrane; Brian Kearney, Naas General Hospital; Catherine Dempsey; Ann Murphy; Olivia Lee; Ger Cully; Sheila Geoghegan; and Fiona O’Brien. BELOW: Integrated Respiratory Rapid Response Team Anna Beechinor, Laura Dunne, Fiona Kavanagh.

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new integrated collaborative approach will ensure a quality patient-centred service leading to better outcomes for this cohort of people who have been diagnosed with respiratory disease. HSE Dublin South, Kildare and West Wicklow Community Healthcare (CHO7), and Naas General Hospital officially launched the Sláintecare-funded Integrated Respiratory Rapid Response Service for Kildare and West Wicklow. Catherine Dempsey, GM for Primary Care, explained, “This new way of working to develop an end-to-end model of care for individuals who are diagnosed with respiratory disease is an innovative integrated approach between the acute sector and community services, to support General Practice and enhance capacity at primary care level.”

The team includes a respiratory clinical nurse specialist and two senior respiratory physiotherapists. This exciting initiative will bring expert care closer to home for patients diagnosed with respiratory disease in line with the principles of Sláintecare. The first Pulmonary Rehab class took place on August 26th 2020 in the new HSE Primary Care Centre, Athy. The team will initiate and develop integrated respiratory care in Kildare West Wicklow

with Naas General Hospital in four different venues, Athy, Celbridge, Newbridge and Blessington Primary Care Centres. Referrals to the team can be made by GPs and by the respiratory clinicians in Naas General Hospital. The team will provide supported discharge for chronic respiratory patients post hospital admission, pulmonary rehabilitation and nurse/physiotherapist-led respiratory clinics for patients with chronic respiratory disease in KWW. In addition, self-management and patient education will be provided for GP clients that are referred to the team.

COVID PHYSIO COURSE A special physiotherapy course has been set up to treat post-COVID patients where their fatigue is so severe that they cannot take part in standard rehabilitation courses. Senior physiotherapist, Respiratory Integrated Care, Brenda Deering explained that she is treating some people that are still so exhausted months after recovering from COVID-19 that they have to go to bed after having a shower. She has designed a specific pre-rehab course to help

them cope and to help them to regulate their breathing. She said that some of those being referred to her have rapid, shallow breathing and, in some cases, they have to relearn the very basics of how to breathe correctly again. “When people have had a chest infection what happens normally is that their respiratory rate increases and becomes faster,” said Brenda, who said that what they want to do is stop that breathing pattern and slow it down, so that when patients are

breathing in and out it is nice and easy.

She said that another problem that can happen is that people breathe through their mouth. Instead they should be keeping their lips sealed. “If you look at a baby in a cot, what you’ll notice is that they are breathing through their nose and their lips are always closed. So, we’ve had a learnt behaviour and learned how to breathe incorrectly. So, we have to unlearn that pattern and learn how to breathe properly again,” she said.

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Programmes

REFLECTING NURSING CARE New nursing documentation booklets the result of multiple workshops

Eleanor Cortez, staff nurse orthopaedics; Caroline Conway, nurse practice development coordinator; Ken Spencer, CNM3 clinical operations team; Lucy McNamara, CNM2 nurse practice development Facilitator; Mary Gormley, senior staff nurse OPD; Triona Dolan-Kirrane, CNM1 orthopaedics; and Ita O’Connor, senior staff nurse OPD. (Photo taken pre-COVID)

Mayo University Hospital (MUH) has introduced a new system of nursing documentation for surgical and medical patients.

The aim is to reduce variance in documentation styles across the hospital and more accurately reflect the nursing care provided to patients during their stay. The new documentation booklet was a result of multiple workshops involving nursing stakeholders from the surgical and the medical directorates, with staff nurse representation at all workshops.

MUH uses the Roper Logan and

Tierney model of nursing, similar to other hospitals in the Saolta Hospital Group.

The main change and benefit of the new documentation booklet is having the nursing assessment of activities of daily living and the relevant care plan together which allows nursing staff to more accurately assess plan, evaluate and record the nursing care delivered during a patient’s stay. This increases the personcentred characteristics of care by applying the person’s problems to their daily needs rather than their medical diagnosis.

In addition, the process of nursing

documentation is streamlined and pre-assessment nurses can document the patient demographics and preassessment in one booklet that is used throughout the patient journey. This reduces repetition for the nursing staff and the patient.

There are two booklets with one designed to reflect the care needs of the complex patient and one to reflect the care needs of the less dependent patient.

The new documentation is designed to work with the Electronic Patient Risk Assessment and Screening Tool.

WAIT LIST MANAGEMENT A new elearning programme on managing waiting lists is now available on Hseland.

The HSE IDPP Protocol 2020 Training Support Programme for Acute Operations Scheduled Care is a 40-minute elearning programme on how to update and generally manage the waiting lists for in-patient, and day-case patients.

The programme developed by the HSE and NTPF is for all staff working in scheduled care in Acute Hospitals including Administration and Business support staff as well as clinical and nursing staff. It could easily be included as part of staff induction in scheduled care.

To access the course please see hseland.ie The course is available under the course headings Clinical Skills and Health & Social Care Professionals.

Laura Mohally, Scheduled Care Department, South InfirmaryVictoria University Hospital Cork, who completed the course, said, “I found the HSEland training module to be very user friendly.

Also I can see great benefits to this training module in particular for new staff members. The different scenarios were useful as it reinforces the message of just how important correct waiting list data entry and completeness is and the subsequent ‘knock on effect’ this can have to the patient should there be an error.”

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Programmes

FROM SCEPTICISM TO CERTAINTY Q CONNECTS ALL OF IRELAND, UK, AND PAKISTAN Zuneera Khurshid, originally from Pakistan, enrolled in UCD and has been working in collaboration with the measurement for improvement team of the HSE’s National QI Team

Zuneera Khurshid

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s a PhD student with a research focus on quality improvement (QI) in health systems, I was sceptical that the COVID-19 pandemic would force QI to take a back seat. However, the experience of observing, participating, and interacting with participants in the ‘Q all-Ireland #RapidQI Virtual Workshop’ revealed that my assumption was far from reality.

The #Rapid QI event With over 190 participants from all over Ireland, the workshop demonstrated the effective use of the virtual domain. We have all experienced turbulence in our personal, professional, and social lives due to the pandemic which can create feelings of loneliness. Participating in the workshop helped me realise that we are in this together. Concerns for the well-being of staff and service users remained a dominant theme alongside the will to learn from the COVID-19 experience and embracing QI. It was remarkable to see how the vulnerability the pandemic brought has been turned into a strength, and the health system has recalibrated

"IT HELPED ME REDISCOVER THE POWER OF STORIES AND SPARKED A DESIRE TO COLLECT AND USE THESE INCREDIBLE STORIES IN MY RESEARCH.”

itself to focus on people, caring for others, showing compassion, and staying connected. This really resonated with someone like me, who was initially unable to return home because of the pandemic.

The research connection The workshop has been useful for me as a researcher as well. I realised that the pandemic would have a lasting impact on how the healthcare system operates and therefore it is important to adapt the research methodology to produce outputs that are relevant and useful. It helped me rediscover the power of stories and sparked a desire to collect and use these incredible stories in my research. It also familiarised me with the use of virtual methods for data collection and the importance of collaboration. Another element that stood out for me was the resilience of the staff and their determination to use this experience to learn from and improve in future.

Collaborating for QI The workshop also introduced me to the work being done by the ‘Q community’ network in UK and Ireland to improve health and care and offered the opportunity to interact with, and learn from QI experts. I believe what made this ‘Q all-Ireland #RapidQI Virtual Workshop’ pertinent for me was that it was grounded in the COVID-19 reality, was multidisciplinary and focused on discussing practical ways to develop a vision for the future together.

For more information contact:Maureen Flynn (Director of Nursing | National Quality Improvement Team, QI Connections Lead). Maureena. flynn@hse.ie Caroline Lennon-Nally. Quality Improvement Advisor, National Quality Improvement Team. Carolinelennon.nally@hse.ie

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Mental Health NORTH DUBLIN MENTAL HEALTH SERVICE IMPLEMENTS MAKING EVERY CONTACT COUNT (MECC) Promoting the physical health of service users Promoting the physical health of service users has been at the core of the North Dublin Mental Health Service (NDMHS) philosophy for several years, enabling service users to live healthier lifestyles and increase positive outcomes on their mental health. As part of a Quality Improvement Plan for the Tobacco Free Campus in the Ashlin Centre, the staff decided to incorporate the Making Every Contact Count (MECC) programme into their daily practice, to promote healthier lifestyle behaviour change. This work was supported with the help of Vicky Doyle, Health Promotion and Improvement officer, in the Health and Wellbeing division of CHO DNCC.

WHAT IS MECC ABOUT? The MECC programme is working to support areas to introduce health behaviour change interventions as part of routine clinical care delivered by health professionals in the health services.

MECC aims to prevent chronic disease by focusing on the four main lifestyle factors for chronic disease: tobacco use, harmful alcohol consumption, physical inactivity and unhealthy eating.

ROADMAP TO IMPLEMENTATION – THE ASHLIN CENTRE APPROACH All 55 staff trained on the eLearning modules of MECC with 30 staff also attending two separate face-to-face workshops between June 2019 and January 2020. The training supports staff to deliver full, regular brief interventions with their service users.

MECC is at the core of the admission process. The MECC Client Record, which is a resource available through the MECC programme, is used as part of the interaction between staff and service user to identify interventions that may be required, or that the service users would like to engage in.

By using the MECC Client Record it enables staff to open up a conversation (brief intervention) with service users in order to effective positive change in their lifestyle, such as referral to an onsite gym, use of the onsite dietitian, or help with alcohol addiction.

“Service users who smoke are very open to brief intervention and engage with staff, many of whom indicate a willingness to try alternatives to tobacco such as Nicotine Replacement Therapy,” said Liam Walshe, A/ADON, Ashlin Centre.

As MECC is part of the Integrated Care Plan of service users, monitoring and review of interventions, progress and enhanced physical wellbeing can be reviewed on a weekly basis and recorded in the service user’s notes, thereby allowing for a record of intervention and engagement.

FUTURE PLANS A NDMHS MECC Steering Group has been established and MECC will feature strongly in their changes and improvement to current practice across the whole of NDMHS. MECC Programme Update

Dr Sarah Smyth and Dr Claire Lynch receiving one of the tobacco information sessions from Fiona Boyle.

For details about how to register to complete the eLearning training programme visit: makingeverycontactcount.ie If you would like more details about MECC implementation in your area please email the National MECC Project team: makingevery.contactcount@hse.ie

The daily staff stretch and exercise session.

MECC I n it iat ives Health and wellbeing initiatives for staff working in the Letterkenny Community Assessment Hub have been implemented by Health Promotion Officer Fiona Boyle since early April.

In addition to the daily work of the Hub, Fiona has taken the opportunity to promote Make Every Contact Count for behaviour change. All the Hub staff members have been encouraged to complete the six online modules of the MECC eLearning.

Regular tobacco dependence information sessions are carried out with GPs, GP registrars, nursing and physiotherapy staff. As a result, clients can be referred to Fiona for smoking cessation advice. She has seen 80 clients in this time and 30 clients have quit smoking (37.5%).

To help promote good physical health and physical activity among the staff, daily team exercise and stretch session take place at 12pm for 10 minutes. Fiona has also set up Attend Anywhere as a flexible additional and/or alternative option to the face-to-face consultations for the Stop Smoking service.

Other health promoting initiatives staff members have engaged with include Stress Control, Steps to Health Challenge & the Irish Heart Foundation Escape Your Chair September Challenge.

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Education

Sexual Consent

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onsent is where there is free and voluntary agreement to engage in a sexual act with someone else. The aim of the podcast segments was to encourage open conversation around sexual consent – what it is and what it's not. Consent is a fundamental part of all sexual activity and relationships and it's a topic that deserves a conversation. The target audience was 18-30 year olds and the podcasters were chosen because of their listeners. We had three podcast segments with The 2 Johnnies and I'm Grand Mam over a number of weeks, from 19 October. We also had a special branded episode with author Caroline Foran on her Owning It podcast. The podcasts had a reach of over 120,000 people.

The HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) launched a new partnership with podcasters in October to discuss the importance of sexual consent.

FURTHER INFORMATION ON SEXUAL CONSENT IS AVAILABLE AT sexualwellbeing.ie/ consent

Key messages in relation to sexual consent include:

What d o we k n ow?

Research by the National Youth Council of Ireland, Consent in the Youth Sector What do we know?, shows that the main issues for young people are:

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Confusion about the concept of consent (58%), e.g. that it’s an ongoing process and that they can withdraw consent at any stage Communication and confidence (23%), e.g. in terms of how to initially begin the conversation on consent with the other person involved

RESEARCH BY THE ACTIVE* CONSENT PROGRAMME SHOWS THAT ...

of young adults agree that asking for sexual consent is awkward for them.

The podcast segments provided listeners with factual information to support their knowledge and understanding of what sexual consent involves and how it’s part of every sexual activity and relationship. The sexual consent message was also shared across our social media channels.

of single students find it difficult to tell a partner what sexual activities they like.

• Consent to sexual activity requires active, ongoing communication to make sure you and your partner understand each other and are in agreement about the sexual act.

• The age of sexual consent in Ireland is 17.

• Being sexually active with someone when they don't fully understand and agree to what's going on isn't consensual sex.

• Giving consent and asking for consent is all about setting your own personal boundaries and respecting those of the other person.

• Even if you consent to a sexual act, you can change your mind before the act begins or at any time before it ends.

• It is not okay for a person to pressurise someone else to have sex.

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Education

Sex Education

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he Economic and Social Research Institute (ESRI) and the HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) held a joint webinar ‘Supporting young people’s sexual health and wellbeing through evidence and practice’ to launch new research from the Growing up in Ireland (GUI) dataset, and new resources that encourage and support parents and children to talk together about relationships, sexuality and growing up.

The newly published ‘Talking about sex and sexual behaviour among young people in Ireland’ report, discussed during the webinar, used data from the Growing up in Ireland ’98 Cohort at 13 and 17 years of age.

The research examines the role of this information in shaping sexual behaviours among Irish adolescents and sexual activity.

Supporting young people’s sexual health and wellbeing through evidence and practice

In relation to learning about relationships and sex, key findings include: • At age 13, 55% of young people reported that they had received relationships and sexuality education (RSE) at school, and this proportion had increased to 92% by age 17.

• There was significant variation in RSE receipt across individual second-level schools, which is in line with previous Irish research that found that policy and leadership at the school level plays an important role in the timing of RSE provision.

• At age 13, 45% of young people reported that they had discussed sex and relationship issues with their parents.

By age 17, this proportion had increased to just under 60%. Young people who had better-quality relationships with their parents were more likely to talk to them about sex and relationships.

The report also analysed sexual behaviours of the older age cohort: • At age 17, 33% of young people reported having had sexual intercourse.

• Young people who had discussed sex and relationships with their parents by age 13 were significantly more likely to have used contraception at first sex.

THE EDUCATIONAL RESOURCES CAN BE FOUND HERE, sexualwellbeing.ie/ for-parents/resources/ or ordered from healthpromotion.ie

The study findings demonstrate that good parental-child communication from a young age around relationships and sexuality can be a protective factor for young people’s sexual health and wellbeing in later life. They support the SHCPP’s approach of encouraging ongoing conversations on these topics between parents and children from an early age. The report also shows that a significant group of young people are not receiving information or advice on sex from their parents, and, although one source doesn’t replace the other, school-based relationships and sexuality education is all the more important for these young people. The findings support the current move towards considering sexual wellbeing as part of broader school efforts to support young people’s wellbeing. continued on next page

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Home is the place where most children first learn about loving, respectful relationships.

HSE SHCPP launched four resources at the webinar to encourage young people and their parents to talk about relationships and sexuality issues.

The resources focus on the development of healthy sexuality rather than the traditional notion of what constitutes ‘sex education’. Sexuality wellbeing is a core part of a person’s overall development and, although it includes the option of sexual activity in adult life, it is primarily about how a person understands and experiences their sexuality in all its aspects. How they develop the values, behaviours and skills to have a healthy relationship with themselves and their bodies, and a healthy relationship with other people, including the option of sexual relationships in adult life.

For children in the home and school setting • Busy Bodies – is a booklet for children about puberty and adolescence. The version that was launched is an updated version of the 2007 publication that has been widely used in homes and schools across Ireland in the intervening years.

This new edition was developed by HSE Health Promotion and Improvement, Cork and Kerry Community Healthcare and the SHCPP, with advice and input from partners within.

For parents The SHCPP is further supporting the development of healthy sexuality in children and young people by publishing a series of booklets for parents under the brand, ‘Making the ‘Big Talk’ many small talks’. These will encourage parents to talk with their children about relationships and sexuality on an ongoing basis; from early years, throughout adolescence and into young adulthood.

The initial books in the series are: • Making the ‘Big Talk’ many small talks: 4-7 years. A rebranded resource, originally published in 2018 as ‘Talking to your young child about relationships, sexuality and growing up’.

• Making the ‘Big Talk’ many small talks: 8-12 years. A booklet addressing the issues of puberty and early adolescence to enable parents to expand on the themes covered in the Busy Bodies booklet for children.

• Making the ‘Big Talk’ many small talks: Healthy Ireland Library Collection. A brochure listing the range of commercial and HSE resources on the topic of relationships and sexuality that have been made available through the HI at your library scheme. These are available to parents and young people in all 330 library branches across the country.

The ‘Talking about sex and sexual behaviour among young people in Ireland’ research report can be found here https://www.sexualwellbeing.ie/forprofessionals/research/research-reports/

MAKING THE MOVE TO SECONDARY SCHOOL EASIER Within Community Healthcare Organisation Dublin North City and County (CHO DNCC) interdisciplinary groups came together to provide support to families who attend primary care services or the School Aged Disability Team, setting up a Moving to Secondary School Group This Group, called ‘MTSS’ began to provide a programme of supports in August 2016, most recently providing an online course in August 2020 for children across primary care and social care (school age) teams to support them in their transition to Secondary School.

Each year since 2016 they’ve listened to what parents, children and the clinicians involved in running the group have said and have improved and expanded the programme. The four-day course in August 2020 was attended by 19 families.

Each day was facilitated by a different discipline: Speech and language therapists facilitated the first day. This focused on communication skills and strategies. Children and their parents worked with the Speech and Language Therapist to create an ‘all about me’ leaflet about the child’s strengths, needs and helpful strategies that teachers can use in their new secondary schools.

Day two was facilitated by the occupational therapists and worked on relaxation and organisation skills, for example practicing mindfulness, organising a folder and reading a timetable.

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Education

Day three was delivered by the psychologists and concentrated on wellness and coping skills.

Following the group many parents and children completed a short online survey. The feedback was very positive, and all the children agreed that they felt more ready to start secondary school following the group.

Almost nine out of 10 reported they found the group helpful.

They said the best things about the MTSS group were the games and group activities, practicing reading about timetables, learning how to deal with your emotions, organising folders and making an “all about me” leaflet.

One child said, “The timetables was great and the all about me leaflet and helping in situations that you are confused with”, while another added, “I liked learning how to organise your folder, how to look after your key and how to deal with your emotions.”

“THE TIMETABLES WAS GREAT AND THE ALL ABOUT ME LEAFLET AND HELPING IN SITUATIONS THAT YOU ARE CONFUSED WITH” A parent said, “My son seems kind of more confident and calm now about the new school. The timing of the group close to the school start was very good.”

Another parent highlighted that “there were a good range of topics covered from the practical to the psychological and I think she will only appreciate them fully when she actually attends.” The helpful tips were mentioned by a third parent, saying, “I notice that my child has started preparing and organising themselves for school by downloading eBooks that go with the text books and labelling their books and copies.”

Pictured at the launch of the trishaw at Dungarvan Community Hospital (from left to right) were: Jill Wilson, Assistant Director of Nursing; Séamus Keyes, resident; Nicola Dunford, Activities Co-ordinator; Paddy Mooney, resident; Antoinette Coffey, Activities Co-ordinator; Kathleen Kennedy, resident; Paula French, Director of Nursing; Donal Connolly, Chair, Residents’ Forum; and Michael Dolan, resident.

OUT AND ABOUT Residents at Dunabbey House residential nursing unit and Dungarvan Community Hospital are looking forward to being out and about in a new trishaw.

The trishaw, at a cost of €9,000 and which features a retractable step and lights, was purchased as a result of fundraising by the Friends of Dungarvan Community Hospital Group in association with the Residents’ Forum at the hospital. The trishaw can also be transported to locations by the wheelchair accessible minibus also donated to the hospital through local fundraising.

The ceremonial cutting of the ribbon to launch use of the trishaw was performed

by Dungarvan Community Hospital resident and Bonmahon native Paddy Mooney, who is in his 100th year.

Subject to adherence to COVID-19 related guidelines and restictions, the trishaw is set to be an additional resource in Dungarvan Community Hospital and Dunabbey House’s activities programme. Plans are in mind to utilise it at locally accessible amenities such as on the Waterford Greenway, in addition to enabling residents to be brought to spots around the town in Dungarvan.

Speaking at the launch of the trishaw, Director of Nursing at Dungarvan Community Hospital Paula French said, “All here in Dunabbey and Dungarvan Community Hospital were delighted when we learned that the Friends of Dungarvan Community Hospital Group had progressed plans to purchase the trishaw. We have a

very proactive Residents’ Forum group, who meet regularly and supports and encourages the residents to be involved and participate at the meetings by way of providing feedback on service delivery.

We empower the resident to voice any suggestions for improvement. Discussion followed as to how it would fit into our activities programme.

“Each resident in Dungarvan is supported and facilitated to develop and maintain personal relationships with family and others, in accordance with their wishes. Each resident is empowered and encouraged to remain as integrated as possible into their community. Dungarvan Community Hospital and Dunabbey House are proactive in identifying and facilitating initiatives promoting residents participation to maintain links within the wider community - ensuring the development and maintenance of friendships.

“We advocate activities and stimulation as integral parts of the life of each resident.

We provide a broad range of meaningful activities that promote physical and mental health and well-being and opportunities for residents to socialise within the community.

Activities are based on each resident’s preference, interests and past activities.

We are confident that the addition of the trishaw, along with our wheelchair assessable bus will greatly benefit the social interactions of our residents within the wider community,” added Paula.

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Lifestyle

"CAN I HAVE MORE SCREEN TIME?" Support for parents on how to reduce child’s device use

“Can I have more screen time?” is a refrain often heard in most households with children. Speech and language therapists in CHO Dublin North City and County, Ashley Carroll, Sinéad Finn and Grainne McKenna worked with psychologists Claire Donohoe and Ailbhe Ruane after becoming aware of this issue and decided to come together to develop support resources for parents and clinicians.

“We were finding that more and more parents were coming to appointments and telling us that they were finding it difficult to limit their child’s screen time,” said Sinéad, adding, “We noticed a lot of children were using tablets and phones whilst waiting for their appointments in the clinics.”

The Speech and Language Therapists and Psychologists formed a group and began researching the topic, creating pamphlets aimed at children 0-5 years old and primary school aged children, posters and a clinician resource pack. This provides clear guidance and recommendations for parents around the amount of screen time, effects of too much screen time, how to use screen time in a beneficial way and alternatives to screen time.

The information is practical, Áine, parent of a child attending speech and language therapy, explained.

“I love the point about the child copying parents on phones etc. Parents need to be mindful of their own actions,” she said.

Ashley, speech and language therapist who worked on developing this, said, “Before I used this leaflet, I would have encouraged parents to reduce the amount of time children spent on screens but I didn’t think about what they could do instead or how they could use screens positively. The leaflet and clinician pack have given me lots of ideas to give to parents like earning ‘screen time tokens’ when the child does other things like reads a book, or having a plan or timetable for when screens will be used.”

Fiona O’ Donoghue, a primary school teacher in North West Dublin, said she finds the resource helpful.

“I hear children chat about their online engagement regularly. Having a resource like this has taught me how much screen time is too much screen time, how to incorporate an appropriate balance of screen time and non-screen time in the

classroom, as well as enabling me to encourage and support parents in limiting screen time at home.”

The posters are for display in the clinic waiting areas and therapy rooms and serve as a visual reminder to ‘turn off and tune in’. The clinician pack contains resources for the therapists to use and brainstorm with parents individually. The leaflets and resources compliment one of the START campaign’s aims to reduce screen time. The START campaign is encouraging parents to put away the screens and pause for play with their children.

The group benefitted from support of the National Communications Division. Sinéad added “we really benefitted from the expertise of Norma Deasy, Communications Campaign Manager, Norma showed us the importance of clear English guidelines and helped us edit our leaflet to ensure it was in line with the NALA guidelines, easy to read and understand, making it accessible for parents and clinicians.”

To find out more please contact the SLT department at slt.dnc@hse.ie The leaflet is available at: https://www.safefood.net/start/reducing-screen-time

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Lifestyle

Lights, camera (take) action!

When the COVID-19 pandemic struck in early March, former nurse Helen Behan knew that she couldn’t sit back and watch. Instead, she joined the thousands of people who returned to the health service to help cope with the virus.

The thing that sets the Co Meath woman apart from her colleagues was the fact that during her stint working in the COVID-19 Assessment Unit in Drogheda, she found out that she had been nominated for a best supporting actress gong at both the British Academy Film and Television Awards (BAFTA) and an Irish Film and Television Awards (IFTA).

Helen had taken a break from nursing after she suddenly found herself catapulted into the world of acting, earning herself rave reviews along the way.

Although she missed out on the awards at the BAFTAs and IFTAs, she said she still can’t believe she had been nominated alongside the likes of Helena Bonham Carter and Naomi Ackie.

“It felt very surreal attending the BAFTA ceremony virtually. However it was the perfect way to absorb everything about it and it probably ended up giving me more time to meet my fellow nominees which may not have happened on the night! It was a lot of fun and it was nice to do all the press from the comfort of my home,” said Helen.

Helen, who has four children, worked as a nurse but had always wanted to try acting.

She was in a pub in her native Bettystown when she met famous English TV director Shane Meadows, who was there on holidays. She got chatting to him and bluntly asked him for a role in one of his programmes. He asked her for her details and she ended up in the Channel 4 production ‘This is England’.

More television parts followed before Helen landed a lead role in the critically acclaimed Channel 4 drama ‘The Virtues’ starring alongside Stephen Graham.

Helen was at back home in Bettystown when the pandemic hit in March.

“The reason I went back to work during the pandemic is that when a national call was put out for staff I felt compelled to help because I could.

They were and are frightening times and I was in a position to do something positive, to help in some way, and so all the health care professionals I know put themselves forward,” she said.

“I was, of course, apprehensive about going into an unknown potentially dangerous environment but once I saw how well organised our area was and that all the necessary PPE was in place, I felt very reassured. Working in the hub was a great experience in that we were doing something positive, helping in a crisis.”

It was just before she started a shift in the hub that she learned that she had been nominated for a BAFTA. “The news about the BAFTA came as a total shock. I woke up that morning to a tonne of messages and that was how I found out. I was about as useful

to them that day as an ashtray on a motorbike so, fair play to them, they let me off a bit early to go celebrate so I was absolutely delighted,” she joked, adding that she still had to pinch herself to believe it.

“For somebody like me who came into it the irregular way that I have, it really is such an honour to be in that category.”

Helen has since finished up her stint in the COVID-19 Assessment Unit and has already filmed her next role. It may well have been her farewell to her nursing career.

“I have worked in many areas of nursing over the years, most recently as a GP practice nurse, and that was a great job. Now however I’m filming most of my time and I’m hoping that there won’t be anymore national calls for healthcare professionals to return to work, as rewarding as it was,” said Helen.

“Nursing has been a great chapter of my life but now my career path has totally changed. I love being an actor and the constant new challenges that brings.”

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Education

Quitting Smoking Take the HSE #LastStop 28-day stop smoking challenge

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housands of people have taken the HSE Quit 28-day stop smoking challenge this year.

HSE Health and Wellbeing launched the challenge this year to encourage people who smoke to give up for 28 days. This is because people who stop smoking for 28 days are five times more likely to quit for good.

Many people who have quit this year have cited concerns over COVID-19 as a reason why they have quit. Research shows that smoking is a risk factor for coronavirus infection. Studies also show that smoking increases your risk of acute respiratory infections like flu. Just like flu, a coronavirus infection may be more severe in people who smoke.

When you stop smoking, the natural hairs in your airways (cilia) and the immune cells that fight infection bounce back and begin to work again to help you fight infection.

Within 1 to 2 days, the oxygen levels in your body will improve. Your blood pressure and pulse reduces, which in turn decreases the overall stress on your body. All these things are good defences against coronavirus and give you the best fighting chance against acute respiratory infections like COVID-19.

So in addition to doing all the things we know protect us from coronavirus - washing our hands properly, covering coughs and sneezes, practicing social distancing and not touching our face, stopping smoking can also help protect you from coronavirus.

Martina Blake, National Lead, HSE Tobacco Free Ireland Programme, offers this advice: “Most people who smoke want to quit but it can seem overwhelming.

Preparing to quit and giving yourself the best start increases your chances of quitting for good. We know that people who stop smoking for 28 days are five times more likely to quit for good.

“That is why we are asking people to take

E-CIGARETTES REPORT

the challenge and kick the habit with support from the Quit Service. We offer many different ways to get help to get in touch and you can choose the support you want and create a plan that fits with your lifestyle. Get in touch with the Quit Service today and see what will work for you.”

There are a number of ways in which people can get help to quit: • A free Quit Kit to help you prepare • Messages or phone calls from the Quitline • Advice on Nicotine Replacement Therapy (NRT) and stop smoking medication • An online-personalised Quit plan where you can track your progress • One to one support from a Stop Smoking Advisor • Daily tips and support from people who have quit and are trying to quit on the You Can Quit Facebook page.

Adolescents who have used e-cigarettes are up to four times more likely to start smoking regular tobacco cigarettes, new Health Research Board (HRB) research has shown.

The HRB recently launched three reports on the public health implications of e-cigarettes and heated tobacco products.

E-cigarettes and heated tobacco products are emerging technologies challenging tobacco control internationally. The HRB evidence reviews were commissioned by the Department of Health to better inform its role in determining tobacco control policy, in particular how best to regulate these new and emerging products in the interests of public health.

In its first report, the HRB conducted a mapping exercise to describe the nature and extent of the peer-reviewed literature on the public health harms and benefits of e-cigarettes and heat-notburn tobacco products to the human population. It identified various harms including poisonings, burns, fractures, lung injury and exacerbations of asthma, including fatalities and cases of long-term disability. Early evidence of damage to cardiovascular and respiratory tissue was also identified, along with carcinogens and biomarkers for cancers.

The HSE QUIT service provides personalised, free support by phone, email, SMS and live chat.

Smokers can free call 1800 201 203 or visit www.QUIT.ie for stop smoking tips and resources, a free QUIT Kit, and to create a QUIT Plan or read other people’s stories. Peer-to-peer support is available on the QUIT Facebook Page www.facebook.com/HSEQUIT or on Twitter at HSE QUIT @HSEQuitTeam #TheLastStop #QuitandWin

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Education MY STORY: SHAUNA STRUTT

You can find the reports here hrb.ie/news/press-releases/single-press-release/ article/new-health-research-board-evidence-shows-e-cigarettes-areassociated-with-adolescents-starting-to-sm/.

The HRB also reported a systematic evidence review of randomised control trials (RCTS) assessing the efficacy and safety of e-cigarettes and heat-not-burn products in helping people who smoke to achieve abstinence at 24 or 26 and 52 weeks.

Overall, it was concluded that e-cigarettes are no more effective than approved and regulated nicotine replacement therapies (NRTs) to help people stop smoking and that their safety beyond 12 months is not yet known.

Finally, a systematic review of longitudinal cohort studies was also reported by the HRB which aimed to explore whether e-cigarette use by adolescents, who had never smoked conventional tobacco cigarettes, was associated with subsequent initiation of tobacco cigarette smoking.

This is an important issue in tobacco control since even experimentation with tobacco cigarette smoking among children and young people is recognised as a risk for becoming a regular smoker. The HRB reported that there was over a three to four fold increased chance of initiating tobacco cigarette smoking for adolescents who had used e-cigarettes.

The HSE Tobacco Free Ireland Programme has noted the key and critical findings from the HRB that use of e-cigarettes by adolescents is associated with an increased risk that they will start smoking conventional, combustible tobacco cigarettes.

Dr Paul Kavanagh, Consultant in Public Health Medicine with the HSE Tobacco Free Ireland Programme, said, “Protecting young people from the harms of smoking is at the heart of what we do in tobacco control. The HRB findings clearly point to the potential for progress in preventing children and young people from starting to smoke to be undermined. This is a serious risk and effective action is required.

“Within our work in the HSE Tobacco Free Ireland Programme we have already delivered new tobacco topic lessons for the Social, Personal and Health Education Junior Cycle curriculum in conjunction with the Department of Education to include a focus on e-cigarettes. We have also been pleased to collaborate with organisations like SPUNOUT to ensure that young people have accessible information on e-cigarettes, as well as conventional cigarettes.”

Shauna Strutt volunteered to be a Quit leader to encourage her HSE colleagues to kick the habit with her back in March as part of the 28-day Quit challenge.

Just nine days into her quit journey, a global pandemic hit – but Shauna resisted the temptation to return to her old habits. Now she is urging people to join the latest 28-day challenge. If you stop smoking for 28 days, you are five times more likely to quit for good.

“I made sure to tell everyone and anyone back in March that I was quitting and that really helped because it was a constant case of peer support. I didn’t want to let anyone down,” said Shauna.

As well as the obvious stresses of COVID-19, she also started a busy new role as Personal Assistant to the Area Director of Mental Health Nursing, DNCC. But the increase in workload was actually a welcome distraction for Shauna, who is now over 10 months smoke-free.

“I took up a promotion in work which threw me right into the thick of COVID-19 management so to be honest it was almost the perfect time to give up because I was so busy,” she said.

It was the boredom of lockdown that presented the biggest challenge to Shauna and her quit efforts.

“Very rarely, and mostly at the weekends, it was the boredom that was the toughest thing to face, especially when we were in lockdown.

There wasn’t much to do and was very easy to almost give in and treat myself with a cigarette because I was working hard and I deserved it; etc,” she explained.

“The temptation was there definitely, and I’ll be honest I did have a slip or two when everything got on top of me at the start but I didn’t enjoy it at all and was more annoyed at myself and disappointed in myself for that so it kept me off them then.”

The boredom aside, the nationwide lockdown, proved to be a blessing in disguise.

“To be honest, I think the fact that the pubs were closed was a boost. I’m a divil for smoking with a few drinks so to not be put in that situation was great,” she said.

Distraction was the key for Shauna as she was determined to stay away from cigarettes.

“If I was sitting on the couch and got a craving I’d get up and move to a different room and do something. If I was in the car, I’d higher up the radio and belt along to whatever song was playing - I apologise if anyone had to witness that. If I was in work I’d get up and fill my water or make a coffee. I just tried to keep it out of my head. I made myself accountable also and I told everyone who would listen that I was giving up so that they could support me,” she said.

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Lifestyle

New healthy eating

guidelines for young children

New national healthy eating guidelines for one to four-year-olds to help parents and guardians to establish good eating habits in their children were launched recently.

The guidelines are based on Irish dietary evidence. This early stage in a child’s life is well recognised as a critical phase when dietary habits are formed. With so many confusing messages and information about food it can be difficult to know what to feed children. With this in mind, the guidelines include a food pyramid which will help people understand what children should be eating, what portion sizes look like and when treats should be given.

Margaret O’Neill, dietitian and HSE Nutrition Lead, and Joanne O’Halloran, Senior Community Dietitian, Primary Care, were part of a team of nutrition experts in Ireland who worked on developing the new guidelines.

“This is the first time we have had food based dietary guidelines in Ireland for this age group. The food we provide for our children during early life is key to their lifelong health and helps them grow, play and learn,” said Margaret.

“All their food at this age, three small meals and two to three healthy snacks in the day, should be nutritious to help them grow and develop. Children grow at such a rapid rate during the first five years - a toddler’s height doubles from birth to three years and body weight increases four times by the age of three. We need to provide them with the right foods to help them with this growth. The new guidelines are very practical and based on the best evidence and I encourage all parents and guardians to spend some time reading through the booklet and learn about healthy meals and snacks, portion sizes and the importance of happy healthy mealtimes for all the family.”

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Lifestyle

VITAMIN D SUPPLEMENT There is also new guidance on Vitamin D supplements for children aged one to four. It is recommended that children take a 5 microgram, vitamin D supplement every day from Halloween to St Patrick’s Day.

More information about vitamin D supplements for young children and the food pyramid is available at www.mychild.ie/nutrition/ The suite of resources for parents and guardians, healthcare professionals and creche managers are available to download from gov.ie/healthyireland/ Hard copies are available to order from available from healthpromotion.ie/

Minding your wellbeing A new free on-line mental health and wellbeing programme was launched in early November by HSE Health & Wellbeing and the Department of Health, with over 800 interested stakeholders participating in the online webinar launch.

The Minding Your Wellbeing programme is an evidenced-based programme focusing on the promotion of mental wellbeing which has been adapted from a face-to-face programme into a series of online videos to make it more accessible to staff and the public at this time. This new resource is part of the range of supports being made available to the public under the new national ‘Keep Well’ resilience campaign which will be unveiled in April 2021.

What does the programme consist of?

The programme consists of five 20-minutevideo sessions, which are available via Yourmentalhealth.ie.

This programme provides a unique opportunity for people to learn more about key elements of mental wellbeing such as mindfulness, gratitude, self-care and resilience. As the public continue to adapt their lifestyles to deal with COVID-19 and are faced with different challenges in this context, this programme aims to provide simple tools and guidance for people to develop and maintain a positive outlook by looking after their mental health and wellbeing.

This programme is the first time that HSE Health and Wellbeing has developed a programme focused on positive mental health for the public delivered in this way.

With an increasing need for and use of online supports, and a move away from face-to-face training, it is hoped that programmes such as this will provide access and engagement for many people who wish to learn about how they can support their own mental wellbeing. While people are being encouraged to complete all the sessions - the sessions are available to access 24/7 - the message is to try one and progress from there.

Other supports are also available for people seeking support from mental health services which can also be viewed at www.yourmentalhealth.ie The Minding Your Wellbeing programme can provide many people with guidance and learning on how to support their own mental wellbeing at this most challenging time.

continued on next page

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Lifestyle PRACTICING SELF-CARE Invites participants to develop and think about their own ‘self-care toolkit’ which includes all the healthy habits we can adopt for our mental health and wellbeing

EASY PEASY RECIPE

UNDERSTANDING OUR THOUGHTS Invites participants to reflect on their own thinking and how thinking patterns can impact wellbeing

EXPLORING EMOTIONS Invites participants to notice their emotions and increase their positive emotions to improve their wellbeing

BUILDING POSITIVE RELATIONSHIP Invites participants to nurture, value and foster positive relationships which are so important for mental wellbeing

IMPROVING OUR RESILIENCE Invites participants to build their resilience, learn about the building blocks of resilience including the importance of focussing on strengths

Feel-good muffins

On Feirm Ground

175g self-raising flour

HSE Health and Wellbeing have been working with a number of stakeholders, including the Department of Agriculture, Food and the Marine, the Department of Health, the Men’s Development Network, Teagasc and IT Carlow, to fund a programme of research that has now resulted in a training programme that will see agricultural advisors engage with farmers on their health and wellbeing over the farm gate.

The research and resource development stage of ‘On Feírm Ground’ has been on-going for the

past twelve months with the first training scheduled to be delivered to agricultural advisors in early 2021.

Based on the research, this training will focus on the individual social determinants affecting the health and wellbeing of both male and female farmers and will adopt a strengthsbased approach to farmers’ health, and set out clear roles and responsibilities and boundaries for advisors in their health role.

For more information about ‘On Feirm Ground’ please contact health&wellbeing. sp&t@hse.ie

50g porridge oats 140g light muscovado sugar 2 tsp ground cinnamon ½ tsp bicarbonate of soda 1 egg , beaten 150ml ¼ pint buttermilk 1 tsp vanilla extract 6 tbsp sunflower oil 175g stoned prune , chopped 85g pecans METHOD

Heat the oven to 200C/gas 6/fan 180C. Butter 6-8 muffin tins or line them with muffin cases. Put the flour, oats, sugar, cinnamon and bicarbonate of soda in a large bowl, then rub everything through your fingers, as if making pastry, to ensure the ingredients are evenly blended.

Beat the egg, then stir in the buttermilk, vanilla and oil.

Lightly stir the egg mix into the flour.

Fold the prunes and nuts into the mixture.

(Left to right) Frank Feighan, Minister of State for Public Health, Well Being and the National Drugs Strategy; Sean Cooke, CEO Men’s Development Network; Martin Heydon, Minister of State for Research & Development, Farm Safety and New Market Development.

Divide between the tins, filling the cases to the brim, then bake for 20-25 minutes until risen and golden. Serve warm or cold.

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Lifestyle

Self-care Delivery For occupational therapists working with older adults, the COVID-19 restrictions had a huge impact on mental health

For occupational therapists working with older adults, the COVID-19 restrictions had a huge impact on everything that we consider essential to maintaining good mental and physical health, explained Claire Matthews, senior occupational therapist; Sharon McMorrow, occupational therapist; and Sharon Cawley, occupational therapy assistant, Liscarney House in Sligo.

“Everything moved online: school, college, shopping, fitness. However, due to the broadband challenges and the fact that almost 50% of adults between 65 and 74 years had never used the internet, we kneaw that ‘going online’ with our service was not a feasible option in the short-term.

We quickly realised that our delivery options for providing Occupational Therapy input to our clients were An Post and telephone,” said Sharon McMorrow.

The occupational therapists identified an activity pack that was being used in The Royal Hospital, Donnybrook to support patients who were isolated as in-patients, and decided to adapt this idea (with permission), to develop a home-based activity pack. Thus, Project Postbox was born.

“The focus of these packs was to support our service users to maintain a routine while cocooning, and to achieve a balance between the areas of self-care, productivity and leisure. The packs contain blank timetables, recipes, exercises, nature activities, quizzes and resources such as radio shows and YouTube tutorials. We included items such as hand creams and herbal teas to really encourage recipients to engage in the suggested self-care tasks.”

All packs served as an adjunct to telephone-based interventions and support from each service-user’s OT. Packs

were developed and individualised based on feedback and each service-user’s unique needs. For example, the text was made darker and the URLs were shortened following initial feedback from the first pack. The frequency at which service users received packs was also tailored to each person’s needs. Packs were further adapted to better meet the needs of people with a diagnosis of dementia.

These packs were again adapted by in-patient services to support activity while social distancing on the ward and as part of discharge packs.

“Feedback from service users has been overwhelmingly positive.

The majority of service users found that the packs were useful, particularly in supporting them to maintain a routine and to stay active during the cocooning period. Service users overwhelmingly identified the nature activities as the aspect of the pack that they enjoyed the most, which is a point that we will consider when developing similar interventions in future.

Self-care and quizzes were also noted as popular aspects of the packs,” said Sharon.

To complete the Project Postbox series, as lockdown came to a close, the OTs asked service users and staff to engage in a small creative crafts under the themes of ‘Together Apart’ and ‘Hold Firm’.

“We sent pattern ideas, templates, wool and needles/hooks to support people to contribute. Several creative pieces have been returned to us and this project was collated by service users who attended the Day Hospital.”

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Lifestyle

KEEPING WELL WHEN WORKING FROM HOME

Staff health and wellbeing is always important but it is incredibly important at this time as we all face the challenges of COVID-19.

HSE Health and Wellbeing are supporting staff to stay healthy and well through the many programmes being made available and these include Steps to Health, our new online stress control programme, Minding Your Wellbeing and a 28-day challenge to Stop Smoking.

Another new support is the provision of Staff Health and Wellbeing Webinars. Sarah McCormack, National Lead Healthy Ireland Lead and Staff Health & Wellbeing, hosted the first of these webinars in October. Due to an ever increasing number of staff now working from home, the theme for this first webinar was Keeping Well When Working from Home.

Sarah opened the webinar and talked about how we can support each other when working from home and how best to manage ourselves to cope better with switching off, having routine and coping with the lack of social connectivity from our work colleagues.

Tina Curran, Irish Heart Foundation, highlighted the increased risk of sedentary behaviour and the need to ‘Escape the Chair’ when at home, and then Margaret O’Neill, National National Dietetic Lead,followed with great direction and practical tips for eating well when at home.

THE FEEDBACK • • • •

•

•

731 joined the webinar on the day.

43.5% completed the feedback survey.

96% said that the webinar topics met their expectations 95% identifying that they had learned something that would help them when working from home 94% said they would attend future staff health and wellbeing webinars.

Mental health, mindfulness/ meditation and exercise were the three top areas that the participants identified for future webinars.

LET'S GET PHYSICAL Tallaght University Hospital open first ever outdoor gym facility for employees. The CEO and members of the Funded by Healthy Ireland, this area is designed to offer staff a place to participate in cardiovascular and strength training alongside friends and colleagues before or after work or even at break time! With six pieces of equipment that target fitness and strength, placed in a socially distanced manner, this outdoor area on the TUH campus is a perfect space to encourage more staff to be more active, more often.

TUH are now proud to be one of the first hospitals in Ireland to have such facilities available to employees.

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Lifestyle

Steps to Health

OVERCOMES COVID CHALLENGES While COVID-19 might have stopped the annual springtime Steps to Health Challenge in its tracks, we regrouped and ran a great programme this autumn

Many team co-ordinators and participants reported that they were strongly motivated to participate this year as it provided a wonderful distraction from the daily pandemic grind and a way to re-connect with colleagues. Some had been out of touch for months due to working in new areas related to COVID-19 and from home.

According to Rachel Wright, Communications Division, “The Steps to Health challenge helped me make time to get out and go for a walk every day.

Like lots of people, I am working from home and noticed that I was missing out on my usual walks to the bus, to and from work and at lunch time. When it’s busy it’s easy to skip exercise. The challenge helped me make walking an important part of my day. Being part of a team was a great motivation to get out, even in miserable weather. I’ve noticed that I feel much less stressed when I take some time for myself and it has been really encouraging to see my step count increase as the challenge went on.”

Despite the unsettling year, we still had nearly 7,000 participants, led out by 900 team co-ordinators. We gained 237 new Twitter followers an increase of 42% on last year and our engagement rate also grew.

The project team of Clodagh Armitage, Noreen Turley and Paul Hickey, Health and Wellbeing; and Norma Deasy, Aine O’Connell and Jennifer Carrie, Communications Division, would like to especially thank the team co-ordinators for inspiring and motivating their staff along with all the participants who got out there and put their best feet forward. We are already in planning for next spring.

O d e to my p e d o m ete r The clip on my stepper got broken So steppy was lost on the way Oh what an awful horrible day Not counting those steps that I’d done Was seriously stopping my fun I could have guessed even cheated About miles completed But lesson learnt and truth be told I’ll never leave steppy out in the cold My dearest friend we’ll stick together From this day on despite the weather You can keep your fancy Fit Bit And those gizmos that flash if you sit Without my best bud My life is no good Such sadness grief and sorrow Maybe you’ll turn up tomorrow Michael Kelly a senior occupational therapist with Mayo Mental Health services shared his thoughts on the Steps Challenge

TOP: Staff at Roscommon University Hospital receiving their certs on completing the Steps to Health challenge.

ABOVE: Aoife Lawton, General Manager, National Health Library and Knowledge Service.

BELOW: Primary Care Team, Clontarf Health Centre on a lunchtime walk in St Anne’s Park.

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Staff Website

Improving internal staff communications in the HSE The HSE Communications Division established an Internal Communications Team in January 2019.

Internal communicators are tasked with the job of communicating with and listening to staff, one of the most important stakeholders in any organisation.

A two way conversation Sometimes internal communications can very much feel like it’s all one way, our inboxes are awash with circular’s, guidelines, urgent system notifications, launch events, training opportunities, the list goes on. These necessary messages are designed to keep you informed about the breadth of activity that’s happening across the HSE on any given day but oftentimes it can feel like the organisation is motoring on ahead regardless of the needs or wants of staff.

Facilitating a two-way conversation between staff and senior management is one main objective for the internal communications team. Pre COVID-19 CEO, Paul Reid visited health care settings up and down the country with the internal communications teams on hand to capture the CEO’s monthly staff video message. These visits were a great opportunity for staff to give feedback directly to the CEO. With the arrival of COVID-19, we have had to find a new way for staff to have a two way conversation with senior leaders.

Webinars quickly became a new way of connecting with colleagues.

An opportunity to ask senior leaders questions in real-time At lunchtime, on July 22nd 2020, the first live webinar Q&A session with Paul Reid, Anne O’Connor and Dr. Colm Henry broadcast and was a great success. There have been two more since

in September and November 2020 and we plan on bring the format back for 2021.

The webinar has become a regular opportunity to discuss, with senior leaders, the development of our service and the particular challenges we’re facing with COVID-19.

The key to the format is there is no agenda and no presentations. It’s 50 minutes dedicated to answering staff questions, which can be submitted to the Internal Communications team before the webinar or can be typed into the chat function during the webinar. Topics have ranged from COVID-19, winter planning, mental health, even some personal insights into our senior leaders management style and what they do to switch off from work pressures.The first webinar of next year is pencilled in for Thursday, January 21st 2021. Keep checking the staff news page for more details.

Getting internal information and news online – healthservice.ie/staff This year we wanted to improve the online experience for staff when they’re looking for internal information. Our main challenge is a large percentage of our staff don’t sit at desktops during their working day. They are on the move, are time poor, and are dealing with significant daily work pressures. We needed a solution where staff could access internal information on any device, and whatever we did online it had to be a good experience on a mobile phone.

STAFF WEBINARS IN NUMBERS (THESE FIGURES ARE THE COLLECTIVE TOTALS FOR THE 3 WEBINARS)

1,567 18,662 121 Number of people registered

Number of page visits to watch back

Number of questions submitted

SOME FEEDBACK FROM STAFF I enjoyed the webinar and felt valued as a staff member.

I am so proud to be part of this HSE team and to work with our Executive leaders Paul Reid, CEO; Anne O’Connor COO and Colm Henry CCO. I have attended all of the HSE Staff webinars to date and I really look forward to listening to them.

Many thanks for this interesting and informative webinar.

Creating this space for HSE Staff encapsulates horizontal networks through the sharing of ideas, generating discussion and creating a more committed, responsive and innovative workforce that can truly depend on the Executive team for clarity and focus.

Staff website project PHASE 1 of improving staff’s internal online experience was to establish a public webpage where staff could access up-to-date information about what’s happening across the HSE. In late December 2019 healthservice. ie/staff/news went live. The page has steadily developed over the last year and there’s a broad range of content and news items for staff to browse. You can watch the CEO’s latest staff message, get information on the latest events and training opportunities and also read the latest instalment in the #OurHealthService blog.

PHASE 2 is launching in December 2020 and it involves publishing a large batch of redesigned content onto the new staff website, healthservices.ie/staff. This first batch is content staff search for and read most often, including information on different types of leave, counselling supports, and information on travel.

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Stay safe at work.

Do not come to work if you have symptoms of COVID-19 infection, are a contact or are waiting for a test.

Remember, the risk doesn’t go away when you are out of the clinical area.

Coronavirus COVID-19 Public Health Advice

Travel to work If you have to share transport, always wear a face covering.

Passengers should sit in the rear of the car, away from the driver.

Keep 2M apart or wear a mask if you cannot keep 2M apart.

H5E 5AFE-T

Break times Keep 2M from other staff.

If you can’t keep 2M distance, wear a surgical mask.

Keeping your distance is safer.

Changing rooms Keep your distance from other staff.

Do not bring personal items into clinical areas.

When you are caring for people, remove your wrist jewellery and fitness bands.

Public corridors and meeting rooms Do not stand talking in groups in the corridors.

Avoid face to face meetings, but, if you must, please maintain 2M social distance.

If you cannot keep 2M apart, you must wear a mask. Healthcare staff should wear surgical face masks in public work areas.

Stay safe. Protect each other.

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EAPandME Employee Assistance Programme

Many of us experience stresses and strains in our work and personal lives and might be wondering if there is anyone there to help.

EAP is a free, confidential counselling service, here to help you. EAP also offers support following a critical incident affecting you or your team.

Call

0818 327 327

to speak to someone who can help.

Go to www.hse.ie/EAPandME to access our online hub of helpful resources

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