- HSE holds second staff survey
- Sod turning for the new Children’s Hospital
- Minister opens Temple Street Extended ED
- Breaches of waiting targets
- Increase in patients treated in 2015
- GPs can now refer electronically to acute hospitals
- Different qualities of life for residents with disabilities
- Overview Report of Disability Inspections
- National Standards for Bereavement Care
- HSE HR awarded excellence certification
- New Hybrid Cardiac Catheterisation
- Patient hotel proposed
- New Drogheda Psychiatric Unit
- Counsellors and psychotherapists
- New charges from next January
- HSE Response to Áras Attracta Report
- New CORU Chair
- No second cardiac cath lab for UHW
- Over 1,800 patients participating in HRB research trials
- New memorandum of understanding
- Understaffing driving doctors abroad
- HIQA endorses patient record model
- Significant increase in infectious syphilis in Cork
HSE holds second staff survey
The second Health Service Employee Survey is due to be launched this September.
The 2016 survey is being conducted to seek the views and opinions of healthcare staff about what it’s like to work in the Irish health services and builds on the first national staff survey carried out in 2014.
The survey will seek employees’ views on a range of themes concerning them directly, such as, culture and values, working environment, career progression and development, equality, diversity and inclusion, leadership direction and communications, staff engagement, managing change, terms and conditions and job satisfaction.
HSE National Director, Rosarii Mannion said a priority action for the Health Service People Strategy 2015-2018 was to conduct staff surveys to ensure that the voice of staff was heard.
“Coupled with this is the need to work with our services to take actions based on the findings. It is very important that as many employees as possible participle in the survey. We need to let all staff know that their feedback is important and will guide us on what we can do to make our services better, both for our service users and for staff,” she said.
Further information can be got by contacting nationalhr@hse
Sod turning for the new Children’s Hospital
Works has commenced on the first phase of construction of the new Children’s Hospital in Dublin.
Minister opens Temple Street Extended ED
The newly refurbished and extended Emergency Department at Temple Street Children’s University Hospital has been officially opened by the Minister for Health, Simon Harris T.D. and Dublin star footballer, Alan Brogan.
The works, which were funded by the HSE and a generous donation from Danielle Ryan and the Cathal Ryan Trust, have meant that a second two-bay Rapid Assessment and Treatment Unit, two extra single treatment rooms and a new reception and waiting area are available at Temple Street for sick children and families.
Temple Street saw almost 50,000 children in its Emergency Department in 2015 and the new facilities have been designed to improve the patient experience by increasing the available space, adding further isolation rooms for treatment and providing more emergency beds.
Speaking at the event, Minister Harris said “The staff in Temple Street do the people of Ireland proud. Their commitment to delivering the best care for children is well recognised and the level of engagement with other children’s services, in particular with the National Children’s Hospital in Tallaght and Our Lady’s Children’s Hospital in Crumlin ensures that young people get the very best of our health service. I would like to commend the staff on their continuing professionalism and their uninterrupted service during the phased refurbishment of the Emergency Department.
”Delivering world-class healthcare for our children now and in the future is an absolute priority for me, and for Government. The delivery of the new children’s hospital is a landmark capital project of unprecedented scale and complexity, and I was delighted recently to mark the occasion of the commencement of the first phase of construction. I know that there is a major body of work required to facilitate the opening, not only of the new hospital but of the new satellite centres at Blanchardstown and Tallaght in 2018, and I am confident that working together, we can achieve the very best clinical outcomes for our children.”
Breaches of waiting targets
There have been 15 breaches of the urgent colonoscopy waiting targets since they were introduced on July 1 of this year.
Three hospital groups have been fined over €11,000 for the breaches.
In July, the HSE introduced a system of a fixed patient charge for breaches of the urgent colonoscopy waiting targets. The charges are applied to hospital groups whose constituent hospitals were found to be in breach of the targets.
The HSE said that in July there were six patient breaches of the target across two hospitals groups. The South/South West was charged €1,500 and Ireland East €3,000.
Increase in patients treated in 2015
Over one and a half million people received inpatient or day case treatment in acute hospitals during 2015 according to the HSE Annual Report for the year, which was published in June.
The report said that overall there was an increase of 19,861 patients treated when compared with 2014.
“Waiting list numbers for inpatient and day case treatments and outpatients appointments improved significantly by December. Arising from the ED Task Force’s Report and analysis, additional funds of €74m were provided in April and following on from this investment, there was a reduction in the number of delayed discharge patients from 719 in December 2014 to 509 in December 2015 – a 29% decrease,” said the report.
“In 2015 the National Ambulance Service responded to 303,502 calls of which 3,810 were ECHO calls (life threatening cardiac or respiratory arrest) and 105,061 were DELTA calls (other life threatening illness or injury). Managing, reviewing and monitoring of ECHO and DELTA response times is a key priority for the HSE. Response times are improving. This is against a backdrop of increased use of the ambulance service with ECHO calls increasing by 22% and DELTA calls increasing by 10%.
The annual report said that the total HSE expenditure in 2015 was €13.895 billion for the delivery and contracting of health and personal social services.
In progressing the HSE Capital Plan 2015, the total expenditure was €388m which included capital grants to voluntary agencies of €84.5m.
The HSE provided funding of €3.621bn to non statutory agencies to deliver health and personal social services – acute voluntary hospitals €1.908bn (53%) and non acute agencies (47%).
Additional funding of €16.9m, which was provided in July 2015 to support acute hospitals over the winter period, was applied to a range of capacity initiatives. Engagement in the winter planning process by community services and acute hospitals saw a reduction of 14% in the INMO Trolley Watch 30 day moving average in December compared with the same period in 2014.
The annual report revealed that almost 1.74m people had medical cards (38% of the population). In 2015, 99.8% of completed medical card and GP visit card applications were processed within 15 days. Over 19m GMS prescriptions were processed in 2015 covering almost 58m items. A total of 431,306 people were in receipt of a GP visit card.
Priorities in mental health services in 2015 included ensuring that the views of service users, family members and carers were central and that timely, clinically effective and standardised mental health services were delivered. Additional governing funding of €35m was provided for continued investment including up to 350 staff over and above the 950 posts funded through the 2012 – 2014 Programme for Government investment.
The annual report said the health service was the largest employer in the state with 120,000 personnel, or 103,884 whole time equivalents (WTEs) employed at the end of December. “This represents an increase of 4.6% or 4,557 WTEs overall in the year and compares with an increase or 2,332 WTEs in the same period in 2014. This increase has been driven by the conversion of agency staff to WTEs.
“Employment growth in 2015 has led to significant employment control and cost challenges. These will continue to be monitored against general affordability, allocated pay budgets and funded workforce plans.”
GPs can now refer electronically to acute hospitals
GPs across the country can now refer patients into every acute hospital electronically following the completion of phase one of the HSE National e-Referral Programme. Over 10,550 e-referrals were received in hospitals in May, up significantly from the 2,289 received in August 2015 when the new process was initiated. Using the e-referral solution, a GP can submit a referral electronically, directly from their practice management system to the hospital in question using the HIQA approved referral form and immediately receive an acknowledgement confirming receipt. The system also enables the hospital to send a response message to the GP once the patient has been triaged.
Different qualities of life for residents with disabilities
HIQA found different qualities of life for residents in 11 residential services for people with disabilities which it inspected, according to 11 reports which it published at the end of August.
These reports related to centres provided by the HSE. In relation to five of these centres, inspectors found evidence of a good quality of life for residents. The provider was found to be ensuring a high level of compliance with the regulatory requirements and providing a good standard of support and care to residents.
Residents in one centre told inspectors that they were very happy living in their home. Inspectors found evidence of care practices that supported residents to exercise choice, and residents were consulted on the running of the centre. In another centre, the HSE had reduced the number of residents and had introduced changes to care practices which had resulted in significant improvements in the quality of life for residents in that centre since the previous inspection.
Residents in one centre told inspectors that they were very happy living in their home.
In another centre, the HSE had made arrangements for a different provider, Muiriosa Foundation, to operate the centre on behalf of the HSE. Muiriosa Foundation has since applied to be the registered provider for that centre. Inspectors found that there had been significant improvements in residents’ quality of life since the introduction of these arrangements, and the registration process for Muiriosa Foundation was progressed on that basis.
The previous provider of two centres, the Irish Society for Autism, had taken court action to appeal HIQA’s decision to cancel the registration of these two centres. The appeals were withdrawn in court and the HSE became the provider of these services. These inspections were carried out to ensure that there had been improvements to the safety and the quality of life of residents following this action. The HSE had made arrangements for Gheel Autism Services to operate the centres on its behalf, and inspectors found significant improvements had been made in safety and quality of life for residents. The HSE was monitoring these services to ensure that improvements were sustained.
Four inspection reports related to centres that are located in large congregated settings. Inspectors found strong evidence of very poor management and oversight arrangements in these centres. They said management was not effective in ensuring improvements in the quality of life for residents, or in ensuring that the rights of residents were promoted and protected. There were significant issues in areas such as the safeguarding of residents from risk of abuse, supporting residents with choices and providing residents with a daily routine based on their preferences rather than staffing arrangements.
The HSE had become provider for one of these centres following court action taken by HIQA to cancel the registration of the centre because of significant failings by the previous provider to ensure the safety and care of residents. Inspectors found that residents continued to receive a poor quality service, and the HSE had failed to address the safety, health and social care issues for residents. In another centre which was the subject of court orders during 2015, inspectors found that while there had been some improvements for residents in a number of areas, there continued to be a high level of non-compliance in areas such as healthcare and risk management in the centre.
Inspectors also found poor oversight arrangements in two small community-based houses operated by the HSE. HIQA said the HSE had failed to ensure that there were adequate arrangements in place to ensure the safety of residents. Issues were identified in areas such as arrangements to safeguard residents from the risk of abuse, the management of restrictive practices, and risk management in these centres.
HIQA said it continues to monitor these centres closely, and will take further regulatory action in relation to them if the provider does not bring about improvements for residents in those centres.
HIQA inspects against the Health Act 2007 (Care and Support of Residents in Designated Centres for Persons (Children and Adults) with Disabilities) Regulations 2013 and the National Standards for Residential Services for Children and Adults with Disabilities, which apply to residential and respite services across all disability services in Ireland.
Overview Report of Disability Inspections
HIQA has published its Annual Overview Report on the regulation of designated centres for adults and children with disabilities.
This report is the first annual overview of HIQA’s regulatory work in relation to centres for people with disabilities.
HIQA inspected 561 of the 937 designated centres for adults and mixed centres for adults and children with disabilities in 2015. There were 741 inspections in total. This report presents an overview of the findings from the 518 announced and 223 unannounced inspections.
Mary Dunnion, Chief Inspector of Social Services and Director of Regulation in HIQA, said:”Initial inspections in 2014 showed there was a lack of understanding on how to meet the requirements of the regulations and the standards. In particular, HIQA found that residents living in many large congregated settings were not being adequately protected or kept safe. Institutionalised care practices that had been ongoing for years were having an adverse impact on the quality of life for residents.”
However, regulation has brought a cultural change to the sector and has steadily led to improvements in the standard of care provided to residents. The inspections carried out in 2015 found evidence of a high standard of care and a focus on individual resident’s needs and preferences in many cases. Some providers were found to provide an excellent standard of care. HIQA found that providers continued to implement improved systems for complying with regulatory requirements and standards. As a result, an overall pattern has begun to emerge showing evidence of positive impacts and improved outcomes for people with disabilities.
Of inspection reports published in 2015, 49 inspections did not identify any actions required while a further 208 inspections required less than 10 actions.
Mary Dunnion continued: “Evidence shows that where there was a competent person in charge, a centre was able to meet the regulations and standards. Good compliance was found in centres where the person in charge had sufficient oversight of the quality and safety of the service being delivered. Residents’ rights, dignity and privacy were respected and measures were taken to improve their quality of life.”
However, she said this was not reflective of practice across all centres. HIQA had been obliged to commit significant resources to risk-based inspections where and when residents’ safety had been breached and had been obliged to take enforcement action in a number of centres during 2015 to drive improvements in the standard of care. Formal enforcement procedures under Section 59 and Section 60 of the Health Act 2007 as amended were used in respect of four centres during 2015.
Mary Dunnion concluded: “If a provider fails to address the areas of concern identified during inspection then HIQA must consider escalated regulatory action. The priority for the person in charge, and for all staff, must be to continue to improve residents’ quality of life. HIQA is committed to continuing to work with services to drive improvements in the quality of care that residents receive.”
National Standards for Bereavement Care
Minister for Health, Simon Harris launched the HSE National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death.
These new standards define the care parents and families can expect to receive following a pregnancy loss or perinatal death and are to be implemented and applied across the health service in all appropriate hospitals and settings.
Launching the standards, Minister Harris said, “I am pleased that the standards will ensure that clinical and counselling services will be in place to support women and their families in all pregnancy loss situations, from early pregnancy loss to perinatal death, as well as situations where there is a diagnosis of a life-limiting or fatal foetal anomaly.”
Dr. Keelin O’Donoghue, Consultant Obstetrician and Senior Lecturer Cork University Maternity Hospitals explained, “All Maternity Hospitals/Units will now establish or develop further Bereavement Specialist Teams to assist and support parents, families and professionals dealing with pregnancy loss. These teams will comprise staff members who have undertaken specialist and extensive education in bereavement care and will include a dedicated clinical midwife specialist in bereavement care for each maternity unit. They will be supported in their work by staff from other disciplines including obstetricians, paediatricians, neonatologists, chaplains, social workers and palliative care teams. The new standards also acknowledge the impact of pregnancy loss and perinatal death on staff and the importance of having formal structures in place to support staff. ”
The standards are built around four central themes:
- Bereavement Care: Which is central to the mission of the hospital and is offered in accordance with the religious, secular, ethnic, social and cultural values of the parents.
- The Hospital: To ensure a system is in place to provide bereavement care and end of life care for babies that is central to the mission of the hospital and is organised around the needs of babies and their families.
- The Baby and Parents: To ensure each baby/family receives high quality palliative and end of life care appropriate to his/her needs and to the wishes of his/her parents
- The Staff: So that all hospital staff have access to training education and training opportunities in the delivery of compassionate bereavement and end of life care in accordance with their roles and responsibilities
The standards have been developed in response to recommendations in both the HSE’s Investigation report into the death of Savita Halappanavar and the report of Dr. Peter Boylan following his review of maternity cases at Portlaoise Hospital.
There is a significant level of pregnancy and perinatal death experienced by parents each year (e.g. 14,000 miscarriages, 500 perinatal deaths, 3,700 terminations abroad).
The HSE is currently putting in place 15.5 WTEs for Clinical Midwife Specialists (CMSs) in Bereavement Care to facilitate the establishment of BSTs across all maternity services. A range of actions have been completed to date to allow recruitment of these CMSs to commence in Q3.
The Bereavement Care Standards make explicit (following termination in Ireland or aboard) that women, parents and families are invited to meet with the Bereavement Specialist Team and are afforded the same level of bereavement care that is given to families who continue their pregnancy. Access to such services may be provided within the maternity or other community based setting.
HSE HR awarded excellence certification
The HSE’s National HR Division was recently awarded Excellence Through People (ETP) certification by the National Standards Authority of Ireland.
In order to qualify for certification of the Excellence Through People 1000:2012 award the HR Division was required to meet the requirements of the scheme and undergo an assessment carried out by an ETP assessor.
The HSE said Excellence Through People provides an improvement model for organisations to enhance performance and realise strategies, through the management and development of their people. The focus of the scheme is to get organisations to look at their people as a key source of competitive advantage.
It said the model helps organisations achieve improvement by:
- Putting the right human resource systems in place to maximise the contribution of employees
- Aligning people practices with the goals of the organisation
- Maximising the investment in human resource management
“The scheme is used by many of Ireland’s most successful organisations in becoming more efficient, productive, flexible, competitive and innovative.
“The benefits for organisations include increased customer satisfaction, greater employee engagement, enhanced workforce organisation, quality improvements, excellent succession planning and greater innovation.”
Commenting on the process Rosarii Mannion, National Director of HR, said: “Our performance as a HR Division largely depends on our ability to improve performance through people.
“The model will help us to achieve improvements by putting the right HR systems in place to help us to maximise the contribution that our staff can make. It will also help us to better match our practices with the goals of the organisation and help us to get the most out of what we are investing in HR management. I think we will see benefits in the areas of employee engagement, workforce optimisation, quality improvement, succession planning and innovation. “
A summary of the key findings reported by the ETP Assessor included the following:
- The National HR Division was in general compliant across the six sections of the ETP Scheme with strengths in business planning, strategic goal deployment, communication, service delivery, employee engagement, learning and development, compliance to legislation and employee wellbeing initiatives.
- A Performance Achievement Review process was applied throughout National HR to all employees and was viewed as motivational by the majority of employees interviewed. Individual training needs analysis is an integral part of the performance review process and linked to continuous improvement within National HR.
- National HR is a very people focused division which views employees as a key source of competitive advantage. Interviewed employees felt valued, well trained, empowered and respected at work. They also felt that National HR has a good working culture with open and transparent communication in place.
- The levels of employee engagement across all areas towards achieving National HR’s strategic goal deployment is a major contributor to the division’s success in meeting its KPIs in key priority areas. Having held discussions with the National HR Director, HR team and staff members the assessor was impressed with the positive feedback regarding levels of support in relation to people development and job enrichment and how this contributed to organisation success.
New Hybrid Cardiac Catheterisation
The new Hybrid Cardiac Catheterisation Laboratory (HCCL) at Our Lady’s Children’s Hospital Crumlin, has been officially opened by Health Minister, Simon Harris and Northern Ireland Minister for Health, Michelle O’Neill, MLA.
The Hybrid Cardiac Catheterisation Laboratory is the only paediatric interventional cardiology service on the island of Ireland.
This lab’s latest technology will avoid open heart procedures in certain cases, use both open heart and keyhole techniques in the same procedure to improve outcomes, allow immediate post-surgical cardiac catheter/angiography to confirm satisfactory result and result in much lower radiation dosages for most procedures.
The project was funded in totality by the Health Service Executive at a cost of €5.6million.
This new Hybrid Cardiac Catheterisation Laboratory has the most advanced paediatric interventional cardiology equipment in Europe. This Unit has been designed to create the infrastructure and technology to deliver cardiac catheterisation procedures to the Children of Ireland, to international standards.
The Children’s Hospital, Crumlin, is the National Centre for Paediatric Cardiology and Cardio-Thoracic Surgery and the Republic of Ireland partner in the Congenital Heart Disease All Island Network, treating approximately 600 patients per year.
It is a new build, located at first floor level, with a direct connection to the Operating Theatres by way of a link bridge. The design enables a group of children to proceed directly from cardiac catheterisation to cardiac surgery without having to change facilities. This was not available to OLCHC previously.
Speaking at the opening Ms. Helen Shortt, Chief Executive said: “The previous cardiac catheterisation laboratory was coming to end of life as it was over 15 years old. As Chief Executive, I am delighted to welcome Ministers Harris and O’Neill today to open this new state of the art facility and, on behalf of the staff of Our Lady’s, I wish to acknowledge the support of and thank the Health Service Executive for recognising the urgent need to replace these facilities and support this new development”.
Patient hotel proposed
The option of a patient hotel for South Tipperary General Hospital is currently under discussion.
A spokesperson for the South South West Hospital Group said that South Tipperary General Hospital has received no official confirmation that it was to receive any beds relating to the patient hotel concept.
“There is currently a capacity issue at South Tipperary General Hospital and additional beds are required to reduce the numbers of patients awaiting inpatient beds on trolleys, and to function at normal operating levels,” said the spokesperson.
New Drogheda Psychiatric Unit
A new multi-million acute psychiatric in-patient unit has been opened in Drogheda.
Helen McEntee, T.D., Minister of State for Mental Health and Older People said: “This is a significant new capital development for people with severe, enduring and disabling mental health issues. The new hospital will provide a modern, safe and secure therapeutic environment, which will greatly enhance the capacity of the local HSE to work with service users and their families to achieve recovery from mental health problems.
“This purpose-built facility of 46 single en-suite rooms will replace the out-dated facilities at Navan and Ardee, and is in line with implementing national policies and best international practice on mental health care.
“The HSE has recruited over 30 additional staff to open this facility, in conjunction with more than 80 new community-based staff across the region in recent times to better support clients in their local areas.
Counsellors and psychotherapists
Interested persons, including health managers, counsellors, psychotherapists, organisations and other bodies have been invited by the Minister for Health, Simon Harris to make representations concerning the proposed designation under the Health and Social Care Professionals Act, 2005, of the professions of counsellor and psychotherapist.
The Minister said ‘I have given careful consideration to the Health and Social Care Professionals Council’s views and I accept the challenges identified by them in moving towards regulating counsellors and psychotherapists under the 2005 Act. The next step is to consider the views of the key stakeholders and I am pleased to be announcing this consultation process and I welcome the views of all the interested parties.’
The Minister said: “Well qualified counsellors and psychotherapists assist people with psychological, emotional and or mental health issues and it is important that their professional and vital services are recognised. My main concern is that, in many cases, there is no statutory oversight of their competence and conduct and that some practitioners lack the qualifications and professional training needed to work with such vulnerable clients. I wish to address this concern and this consultation will be a significant step in formulating the best way forward.’
The Minister asks that submissions be sent in writing either:
- By Post: Public Consultation, Professional Regulation Unit, Department of Health, Hawkins House Dublin 2, D02 VW90
- Email: firstname.lastname@example.org
- The closing date is November 30, 2016.
New charges from next January
Legislation will be commenced on January 1. 2017 to introduce new contribution arrangements towards maintenance and accommodation costs in certain long-stay residential settings.
The Department of Health said the new contribution framework would replace existing long-stay charges, with rates remaining unchanged.
- These revised arrangements will not apply to residents supported under the Fair Deal Scheme.
- Each service user (and/or their family member/personal advocate) will be contacted individually and will receive full details of the revised arrangements as well as receiving an individual assessment over the coming months
- Additional funding of €1.75m is being made available to cap the maximum contribution in non-nursing settings at €70 per week
- Comprehensive waiver provisions will ensure that service users will only be required to contribute within their means, taking account of any individual circumstances that may apply
The legislation which introduced these long-stay contributions was passed by the Oireachtas in July 2013 and November 2014. A Department spokesperson said the revised arrangements would achieve greater consistency and fairness for service users where accommodation and/or maintenance is provided directly by the HSE or by a section 38 agency funded to provide services on its behalf.
“The relevant legislation was enacted to update the State’s legislation in this area; to better reflect the emerging models of residential care and to complement current government policy of moving from congregated settings to homes/independent living in the community, particularly in the disability and mental health sectors.”
“The new Residential Support Services Maintenance and Accommodation Contributions (long-stay contributions) framework apply also to approximately 1,700 service users in the mental health and disability sectors who reside in non-nursing community settings funded by or on behalf of the HSE. The majority of these residents will contribute at the same or a lower level than at present – for instance, over 1,100 service users will contribute less per week. The new regulations will also allow for greater consistency and fairness as service users will contribute at a standardised level. The maximum weekly contribution rate will be €10 per day (€70 weekly) in these settings. Existing rent/kitty arrangements may continue except that the amount will be capped. Additional funding of €1.75m is being allocated to the HSE to support the new arrangements. Residents in such independent living settings will, after their contribution to accommodation and daily living costs is made, will be assured of retaining at least €118 of their weekly income for personal use.
“The contributions relate only to accommodation and daily living costs, including food and utilities. There is no contribution or payment requirement in relation to the health-related care or services provided.”
HSE Response to Áras Attracta Report
The HSE response to the recommendations of the Independent Report of the Áras Attracta (McCoy) Review Group is grouped under three main headings – transitioning residents to community living, ensuring the voices of residents are heard and new governance, leadership and management.
The HSE has also outlined the programme of improvements underway in safeguarding and disability services nationally by the HSE through the Community Healthcare Organisations (CHOs), in parallel with Dr. McCoy’s Review.
The findings of the Review Group are presented over a series of three reports:
- What matters most sets out the findings of the Review Group in relation to Áras Attracta itself. It includes recommendations relating to Áras Attracta management, actions for the HSE at a national level, and a plan to guide all managers of congregated settings as they move towards decongregation.
- Time for action deals with the wider system of service provision for people with a disability, and proposes a range of actions to inform national policy across government departments that emerged from a national process of consultation with stakeholders involved in disability services and the wider public.
- Start listening to us is a documented record of the lived experiences of people with intellectual disability and how they perceive the support they receive.
Chair of the Review Group, Dr. Kevin McCoy said, “Critically, in our review, we found the model of care at Áras Attracta to be wrong. The model did not respect the residents as individuals. They have suffered isolation and institutional conditioning. There was an assumption that the residents could not contribute and do things for themselves. They have been unable to reach their potential. The residents have had a poor quality of life, and their voices have not been heard.
“To move on from this report, services for people with intellectual disability must be person-focused and needs-based. It is important to not only maintain the health of people with intellectual disability, but to include them in social life and respect them as individuals. Services should be provided in the community, rather than in isolation. This is now well-understood. The HSE has commenced the delivery of key infrastructural changes that are recommended by this review. However, at a national level, while policy favours support for people with intellectual disabilities in the community, the pace of change is still too slow.”
Transition to community living
The HSE says that at Áras Attracta, the HSE has been moving steadily towards a community based model of support for the residents. This is guided by the national report ‘Time to Move on from Congregated Settings’ the core recommendation of which is that people living in congregated settings should be supported to live in the community with appropriate supports.
It said a roadmap for Áras Attracta, which it has published, outlines how it will enable residents to make this transition to community living. This roadmap aims to facilitate further consultation and discussion with service users, residents, their families and advocates, staff and other key stakeholders about how the HSE’s vision for Áras Attracta will be implemented.
The HSE said the transition to community living will happen on a phased basis. This is informed by the results of the residents’ individual assessments. It is proposed this will happen in three phases:
“Phase I – commencing this year, 27 residents can start the transition to community living with additional supports as appropriate.
“Phase II – commencing in 2017: a further 26 residents can start to transition in accordance with their individual needs assessments. The residents will require significant additional support and time to progress to community living.
“Phase III – commencing in 2018, this phase will involve a comprehensive programme of communication and engagement with 37 residents and their families about choices and options for their future. Phase III residents have significant complex needs, ageing or medical conditions and will require additional transitional planning and time to ensure that the most appropriate supports and service are provided for them in accordance with their individual needs assessments. Planning is underway for this third phase.”
A HSE spokesperson said: “While it is important to set targets in order to maintain focus on the overall objective, ultimately these timelines will be heavily influenced by the readiness of residents to make the move and consultation and engagement with their families and/or advocates.”
Voice of the Residents
The HSE said that with the support of Inclusion Ireland, a Family Forum had been established in Áras Attracta and in a number of other residential settings to ensure the voice of service users, their families and advocates are included in all that they do. CEO of Inclusion Ireland Mr. Paddy Connolly said, “Inclusion Ireland will help build the capacity of staff and residents to ensure the voices of the residents are heard. We will also support families of residents to engage with management and staff regarding the future provision of services at Áras Attracta.”
Governance, Leadership & Management
The HSE said an important recommendation emerging from the review group was the change in management and governance structures at Áras Attracta.
“In 2015, a new Director of Services was appointed to manage day to day operations and oversee the ongoing change programme. Áras Attracta was reorganised into three designated centres, each with a Centre Manager, with services tailored specifically for residents’ needs.
“A dedicated project manager, working with two full time transition co-ordinators, has been appointed to lead the change management team and the transition to community. This team has the necessary skills to drive forward the change programme at the required pace and to ensure the voices of all concerned are heard.
The residents have had a poor quality of life, and their voices have not been heard.
“In tandem with the work of the McCoy Review Group, a six-step system wide programme of measures to enhance service quality and improve safeguarding practice in disability services was established in December 2014. Led by a National Implementation Task Force and working with CHOs, service providers, and voluntary partners, the purpose of the programme is to give oversight and direction to local plans and local action, and to ensure quality and safety of all services through empowering and safeguarding of vulnerable people.
“Through the implementation of Transforming Lives and the Six Step Programme the HSE will progress the implementation of all the recommendations of the McCoy Review Group.”
The HSE commissioned the McCoy Review Group to undertake an independent review of the quality of care following the broadcast of the Prime Time programme ‘Inside Bungalow 3’ by RTE in December 2014 being provided in Áras Attracta.
Welcoming the findings of the Review, Mr. Pat Healy, HSE National Director, Social Care said, “I wish again to apologise unreservedly to the residents of Áras Attracta and their families for the manner in which they were treated. I want to thank Dr. McCoy and the members of his Review Group for their work in producing this set of reports. Their recommendations support our vision for Áras Attracta, and for other residential disability services nationally, which is to move to community living, supporting people with disabilities to live lives of their choosing, to decide where they live, who they live with and how they spend their time.”
It is important to not only maintain the health of people with intellectual disability, but to include them in social life and respect them as individuals.
Mr. Tony Canavan, Chief Officer, HSE Community Healthcare Organisation 2 (Galway, Mayo & Roscommon), also thanked Dr. McCoy and his team for a very comprehensive review of services at Áras Attracta. He noted, “Their report captures the voice of the residents at Áras Attracta and this is particularly valuable in assisting us in our redesign of the services at the centre.”
New CORU Chair
Prof. Bernard McCartan has been appointed by the Minister for Health, Simon Harris T.D. as Chairperson of CORU, the Health and Social Care Professionals Council.
CORU is Ireland’s multi-profession health regulator, responsible for regulating health and social care professions. The statutory body comprises the Health and Social Care Professionals Council and the Registration Boards for each profession regulated by CORU.
Prof. McCartan has extensive experience promoting high standards across the health and social care sector. He has held a number of positions in the areas of regulation and fitness to practise, having previously served as President of the Dental Council and Chair of the Professional Conduct Committee of the Pharmaceutical Society. He was first appointed to the Health and Social Care Professionals Council in June 2014.
Professor McCartan is Visiting Professor in Oral Medicine in Trinity College Dublin and was the first Director of Specialist Training in Dentistry in Ireland. He was formerly Consultant in Oral Medicine in the Dublin Dental Hospital, Hume Street Hospital and the Blackrock Clinic.
Commenting on his appointment Professor McCartan said, “I am pleased to be taking on this role at a pivotal time for the work of CORU. Independent regulation is critical to protect the public and as a consequence should enhance the professional status and standing of the professionals. The public must have confidence in the standard of care they receive from health and social care professionals and we will ensure high standards of education, training and competence across the professions regulated by CORU.”
“My priority will be to work with the Department of Health, Council, the Registration Boards, our Chief Executive, Ginny Hanrahan and Executive team to build a sustainable regulatory model that supports health and social care professionals dedicated to operating to the highest standards, while imposing sanctions on those found guilty of poor professional performance or professional misconduct”.
CORU currently has registers open for the following professions: Dietitians, Occupational Therapists, Radiographers and Radiation Therapists, Social Workers, Speech and Language Therapists, Optometrists and Dispensing Opticians.
No second cardiac cath lab for UHW
Health Minister, Simon Harris has accepted the independent clinical review carried out by Belfast based NHS cardiologist Dr. Niall Herity, who said a second cardiac cath lab at University Hospital Waterford was not justified.
The Herity recommendation was rejected by Dr. Patrick Owens, Consultant Cardiologist at UHW who told the Irish Times that the Department of Health “queered the pitch” for the review by imposing terms of reference that ignored the key issue of clinical risk. This ensured the author of the report, Dr. Niall Herity, who recommended some services be moved from Waterford to hospitals in Dublin or Cork, “asked the wrong question,” Dr. Owens told the newspaper.
Dr. Herity also recommended investing in UHW to enhance the existing cardiac services, including increasing the number of weekly sessions currently provided, in order to address waiting times and to provide improved access for patients.
He recommended that some services be provided elsewhere but that in order to do this a number of operational processes would first have to be embedded.
Said Minister Harris: “As Minister for Health, I have to be certain that any change to how a service is delivered will result in improved services for the patients using that service. Therefore, I have asked my Department to address the implications of this recommendation by undertaking a national review of all primary PCI services with the aim to ensure that as many patients as possible have access on a 24/7 basis to safe and sustainable emergency interventions following a heart attack. I expect the review to be completed by the end of July 2017.
“Dr. Herity also recommends that new specialist equipment be provided in UHW to improve contingency for radiological equipment failure during a procedure. I am happy to provide the additional resources necessary to implement these recommendations, and as such, significantly improve services for patients at UHW. These resources will provide for the following range of developments in the hospital, the investment for which will be reflected in the Estimates and the National Service Plan for 2017:
- The newly refurbished singular cath Lab to provide an additional eight hours per week of procedures, which will allow for additional patients to be treated and will lead to fewer cancellations.
- The requisite staffing for the additional sessions in the cath Lab.
- Radiological equipment including a portable fluoroscopy with an image intensifier which will alleviate existing concerns around potential failure of equipment during a procedure.
- An increase in non-interventional consultant staffing so that UHW can establish a general cardiology on-call service where all cardiac patients (other than out of hours STEMI) are admitted directly under the care of a general cardiologist. The HSE will progress plans to appoint the necessary consultant posts to deliver this service. In this context the Consultant Applications Advisory Committee will prioritise the consideration of the three applications that have been made by the hospital, in addition to the two new academic posts approved recently, namely Professors of Orthopaedics and Oncology.
“During this period of investment and enhancement of services, the situation will be closely monitored. To assess the impact that these improvements have had on the volume of patients attending the Cath Lab, I will have a further independent review carried out in early 2017.
Dr. Herity’s report is available on the Department of Health website.
The Programme for Government committed to the development of a second Cath Lab in University Hospital Waterford, subject to a favourable recommendation from an independent clinical review of the needs of the region to be carried out within six weeks.
Over 1,800 patients participating in HRB research trials
There were 1,827 patients participating in trials at the three Health Research Board Clinical Research Facilities in 2015, according to the HRB annual report for the year.
The HRB awarded a total of €41.5 million for research last year and opened a new HRB Clinical Research Facility in Galway.
The HRB said its current strategy, which ended in 2015, resulted in an investment of more than €227 million over the six year period in a wide range of research ideas that will result in better health and better care.
HRB Chief Executive, Dr. Graham Love said that these included:
- Increased support for population health and health services research by 48%, compared with the period 2005–2009.
- Consolidated health information systems in order to better support service planning.
- Transforming the infrastructure for clinical research in Ireland.
- Opening three new clinical research facilities.
- Creating four new clinical trial networks.
- Establishing a trial methodology research network and a hub to coordinate clinical trials.
- Establishing an evidence centre known for producing quality evidence to inform health policy.
The annual report said that during 2015 alone the HRB had:
- Invested €41.5 million in 125 new research awards.
- Supported more than 300 research jobs.
- Started work in clinical trial networks in stroke, critical care, primary care and mother and baby care.
- Opened the HRB Clinical Research Facility in Galway.
- Supported researchers in securing more than €14 million from Horizon 2020.
- Generated five major evidence reviews to inform health policy in areas such as suicide prevention, water fluoridation and the food pyramid.
- Launched the HRB Trial Methodology Research Network.
- Formed the national network HRB Clinical Research Coordination Ireland (HRB-CRCI).
- Introduced four new clinical trial networks.
Said Dr. Love: “We now see the ‘jigsaw’ coming together, which will lead to a seismic shift in Ireland’s ability to attract and participate in international clinical trials. This infrastructure will create a safe environment for patients to participate in research, will enable health professionals to test innovative therapies, technologies and products, and will increase the pace at which scientific discoveries and innovations are turned into better outcomes for patients. Ultimately, our goal is to create in Ireland an environment where any patient who presents for care, and who is suitable to participate in a trial, can be offered the chance to participate in one, thus giving them access to the latest treatments available in a safe setting.”
New memorandum of understanding
HIQA and the Nursing and Midwifery Board of Ireland (NMBI) have signed a Memorandum of Understanding (MoU) on areas of potential cooperation and collaboration in the interest of ensuring appropriate assessment of information by NMBI and HIQA and the protection of the health and welfare of people who use health and social services in Ireland.
HIQA says the new MoU aims to promote collaboration in areas of common interest where cooperation will lead to better services and better outcomes for people using health and social care services.
“HIQA and NMBI will communicate as appropriate on all matters of strategic and mutual operational interest on a formal basis and will facilitate cooperation on cross-referral of information where one organization believes it falls within the remit of the other and where there are concerns in relation to the professional standards or conduct of nurses or midwives.”
Mary Griffin, Chief Executive of the NMBI, welcomed the development and said: “This collaboration between NMBI and HIQA will support us in continuing to work together to protect the public and maintain high standards of patient care. This MoU is another step in delivering on partnership across government agencies in promoting the patient safety agenda.”
Phelim Quinn, Chief Executive of HIQA, said: “This MoU will underpin future cooperation between our two organisations and assist in our shared vision of protecting the health and welfare of all of those who use health and social care services in Ireland. We are delighted to put already informal cooperation between the two organizations on a more formal basis.”
Understaffing driving doctors abroad
One fifth of Irish trainee doctors intend to either definitely not (7%), or probably not (13%), practise medicine in Ireland for the foreseeable future.
This emerged from the Medical Council’s 2015 Your Training Counts report on the career intentions of trainee doctors, published this summer.
Findings from the report include:
- Intern trainees were most likely to say they did not intend to practise in Ireland for the foreseeable future (27%).
- The three largest influences on trainee intent to leave medical practice in Ireland were, understaffing in the workplace (82%), carrying out too many non-core tasks (75%), and limited career progression opportunities (72%).
- Trainees who were bullied during training were more likely than those who were not to say they were leaving medical practise in Ireland. The UK (30%), Australia (21%), and Canada (21%) were the most frequently mentioned destinations for trainees with intentions to practise elsewhere.
- Fifty eight per cent of trainees see themselves practising in Ireland for the foreseeable future, up 4% on last year.
Speaking about the report findings Professor Freddie Wood said: “Doctors in training are the future of our health service and it is absolutely essential that their voices are heard. Increasing numbers are emigrating in search of work elsewhere and the health sector therefore has to address the issues highlighted in the survey.”
Medical Council CEO, Mr Bill Prasifka, said: “Eighty two per cent of trainees who reported that they were considering practising medicine abroad said they were going to leave because their workplace was understaffed. Although we are acutely aware that this is an ongoing issue within the Irish Health service, it is our aim to ensure this information is highlighted across the health sector so that proportionate and targeted actions can be taken in key areas requiring reform thus enhancing the quality of training for these doctors.”
Your Training Counts, the annual national trainee experience survey, is designed and delivered by the Medical Council and aims to support the continuous improvement of the quality of postgraduate medical training in Ireland. This is the second year of data published on the career and retention intentions of trainee doctors in Ireland.
HIQA endorses patient record model
A new review of international evidence and best practice by HIQA has concluded that using a central secure record of people’s medical history can help to improve patient care and safety by giving healthcare professionals timely access to relevant patient information to guide care and treatment, such as in an emergency department or a pharmacy.
A summary care record is defined as a structured summary of key medical information on individuals, held centrally on a national database that is only accessible over a secure network from anywhere a patient seeks treatment, such as a hospital emergency department or a pharmacy.
HIQA looked at the evolution of ‘summary care records’ in other countries. The review considered summary care records in the UK, Australia, New Zealand and The Netherlands, all regions being strong leaders in delivering eHealth initiatives.
HIQA’s Acting Director of Health Information Dr. Kevin O’Carroll explained: “A summary care record is usually created automatically from existing records. It is usually held in a central national location, accessed on a secure network, and it usually contains key elements such a patient’s name, address, age, allergies, current medications and diagnoses.”
“We recognize the importance of adopting summary care records and the potential they have to increase the quality and safety of health and social care in Ireland. While research in the UK has shown implementation of a nationally shared electronic summary record is a highly complex challenge, most individuals and clinicians in the regions covered by this HIQA review are positive about the concept of being able to view a secure summary of key medical information.”
In each country reviewed, common information that was included in the summary care records included patients’ details, medications and allergies. Also, the source of information that was used to generate the summary care records came mainly from primary care, specifically from family doctors.
Dr. O’Carroll concluded: “This review can help to inform how a national summary care record could be developed in Ireland and will help inform implementation in this area. Areas such as governance, evaluation of their use and appropriate patient permission models to share information will need to be considered.”
Significant increase in infectious syphilis in Cork
There has been a significant increase in cases of early infectious syphilis in the Cork area in the past year, with almost 8 in 10 reported cases among men who have sex with men (MSM).
Compared to January to June 2015, when seven cases were reported in Cork and Kerry, cases have trebled, with 23 cases of early infectious syphilis reported from July to December 2015 and 21 cases from January to June 2016.
The HSE Department of Public Health in Cork has expressed concern and is encouraging all sexually active men who have or have had sex with men, and women whose partners have sex with men, to get tested for sexually transmitted infections (STIs) and always use a condom when having sex.
Syphilis is a sexually transmitted infection (STI) caused by a specific type of bacteria which, if not treated promptly and with the correct antibiotics, can cause long term serious problems. It is passed from person to person during unprotected anal, oral or vaginal sex, or by sharing sex toys with someone who is infected.
The first symptom (primary syphilis) is usually the appearance of a painless sore at the location where syphilis entered the body, but syphilis has been called the ‘Great Pretender’ as its symptoms can look like many other diseases. Up to half of people with syphilis may not notice any symptoms, therefore it is vital to get tested.
In relation to the rise in Cork, Dr. Aileen Kitching, Consultant in Public Health Medicine at the Department of Public Health in Cork said: “The cases we are seeing are mostly in men who have sex with men with over half of male cases in older adult age groups, over 35 years of age. Around 1 in 5 of these cases have had one or more other STIs. Increased public awareness about STIs including signs and symptoms and where you can get tested is essential. Having syphilis once does not protect a person from becoming infected again. Even following successful treatment, people can be reinfected. So, unless you know that all of your sex partners have been tested and treated, you may be at risk of getting syphilis again from an untreated partner. We also remind everyone of the importance of using a condom every time they have sex.”