Mid-Western Health Board Annual Report 1997: a newbeginning

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Authors Mid-Western Health Board (MWHB)

Publisher Mid Western Health Board (MWHB)

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1997 MID- EALTH BOARD A NEW BEGINNING

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Letter From Our Chairman

.Tack &urk, C ~AIRMA N MlO·VIESTfRN HEAll H BOARD

h gives me grcar pleasure as Chaicman of <he Mid-Wcscem Health Board eo introduce this Annual Report for <he year 1997.

The Report sc<S out <o paint a 'broad brush' review of the activities and range of services which were provided during 1997. Incvhably, only a small number of these can be included when one considei'S <hat the Board aims eo pcovide health and social gain for a population of317,069 over an area of more rhan 3,000 sq. miles and <mploys mor< than 4,000 people in a very wide range of professions and disciplines.

The year broughc changes borh in rhc constitution of the Board and in the Executive. Mr. Denis Dohcrty. who was Chief Executive Officer for a period of nine years left at the end of Janu;~ry, and I would like ro rake this opporrunity to pay a specW tribme ro h is dedication, commicment and farsightedness during <he period of his dual appointment as Chief Executive Officer of both this Board and <he Midland Healrh Board. I would like to wish him well io his new appointment as Director of <he Office for Hcaltb Management. He of course retained his position of Chief Executive Officer of the Midland Health Board.

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Mr. Sciof:l.n del\ urea took up ducy as Chief Executive Officer in November and l take this opponunicy to publicly congrarulate him on his appoinro1ent and wi>h him well for his term of office. Significanr changes are occurring in the relationship between rhe Board and r!1e Executive. Some of these are nooessary because of change.< in kgislation and some are due to developio~; a pannership approach between the members :utd F.,xecurive. T hese were discuss~d at a workshop aneoded by members of the Board and the Executive at the end of November and I look forwa•·d tO this relationship growing and developing over the Coming year.

Elections of professional members of the Board t(•ok pl~ce in May, toged1er wirh rhe nominati(ln of representatives by the Mi.nister for He.'llth. I would like to pay a special tribute ro the work carried out by the oU!going members of the Bo:trd and also ro wish those who were elected and nominated a fruitful, productive and enjoyable tcm1 of office.

Finally, ir is with great sadness rhat 1 record rhe deaths of rwo long serving members of the Board. Cllr. Paddy Bugler died in Aprill997 and was a member of the Board from its establishment unril his death. Cllr. Binkie Hanafin died in early '98 afrer enduring a long illne$s wirh remarkable bravecy and without losing her grcar sense of humour. The wise 'tlld pertinent contributions of both these members will be very sadly missed by the Board. Ar dhcis lamh Dt go raibh a n~anam.

jack Bourke Choinnan

Stiofiin t1dlt1rt<l

M Westenz Hea B rd

Our Chief Executive's Overview

PRIOMH OIFIGEACH FEIOHMEACHAIN I.IIO·WESHRII HEA\TH BOARD

Increasing public expecrari011S and rhe management of limited resources 10 improve services and their performance raise issues which have to be reconciled with reo.liry. Prioritisacion and rationing, ba.<ed upon. capaciry, capabiliry and needs assessment are the realities which oll be.,lrh and personal social service systems far.e today. No single org;misarion or service system can meer rhe aims ofhealrh and social g:oin for a defined popularion. Strategic alliances, networks and partnerships in purpose and delivery are now more essential thart ever. To gener•te a climate of change, so as ro facilitare such arrangements, it is necessary for us ro review our ...Uues and identiry ar all levels. A process commenced in 1?97 of producing strategic statements of intent and action which are srakeholder influenced. A corporate and operational srrucrures review initiative got underway. This was in randem with tbe major processes review now associated with the implementllrion of rbe Freedom of Information Act.

11, . aim is ro re-orient to • v:olues :llld outcomes driven organisation which is patient/client centred and population focused. To achieve total system ioregrarion, im~ro:ol and external, a lor of effort and commitment is being sought to encourage and improve the levels of participation and iovolvcmcnr.

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IMPROVEMENTS IN PRACTICE

TI1e development of Care Models 10 g;,., effect to Service Stweg•cs, 1og<~her ~nh ~ervice ~nd . dinical pa<hway> development, arc indic.uive of our de<i"' to seck hcucr pracu« m all "'"""''of <ervice delivery. Of necessily this appro"'h focuses allt111ion on the role anti l'~rformancc of •ervice faci~cics ond providers. Change bring' some uncertaint:y. fhis i> beiu!\ .tddre-sed hy developing a People Stratogy ~nd moving gr.ulu~lly to • mort cv..Ju.11i<e cuhurc which will•dtlrc'-' ~crvice outcomes from the pc-rspecti\'e., of our prim>'l')' ~takehol<h.'r~. fhi~ rttlulrc-. improvtmt'llf'\

in practice, information. communiC3cion~ and participotlion.

Rnource iuvesunem and manogemem IS demon mated in "'" ( 1 9')7) Repon un <er\'le< perform3Jtce. Significant improv<:m<nt> md priority i"ues are 1dtntilie-d

Acute Servico 3tt a major u.)t!r of caplral and revenue rt".SOur~.;.e,. The rev~nuc lmpltt.t[ions of l'hose I and 11 of the Regional Hospi1al Limerick. rogctbcr wid1 the tummhsioning and <k'<anting co;rs hav.: robe met"' as to fully avail of <he emerging 'stare of rhe art' facilitiC> in Dooradoyle The Ennis and Nenogb Genet:!l Ho>pir..l Project~ mociated wirh the Acu1e P<ychia<nc Unit'> development still awair Dcpanmtnt of Heal m ~pproval to procee-d to desigu \tagc. Ward ;tntl

equipment upgrndes continued during 1997.

A<tivity in the Regional Hospit.•l Complex i; on a continuing growth rrend with <he lr1crcasc in dinic..l spedalties and o"et:!ll levd1 of refert:!ls. The bed occupancy by older people i< indic:mivc of the nee-d to improve service practice and <he cme system for rhcm. Generally. activity level< in Ennb and Ncnogb Genet:!l H~piwls perform on targeted projt-crions. Overall, acurc care h'ts to be ~ubjecrcd ro continuous monitoring in respect of performance and cosr.

Services for older people are improving. with greater cmpho.i> on appropriate imervcncion' an<l ;uppon sys1en1>. Huw.ver, they .tre fragmented and need greater coheston in <ervtce management and user-provider linkages. There is a dear imbalance in <he cominuum of care which has 10 be •tldres,cd by resouR~ shift and! or additional inve.<rmenr.

A YEAR Of CHALLENGES

Children and fumilo"' heal1h and wdfare arc nccc>Sarily lonked through a series of service elementS. l'rimJry Care, Child and Maternal Health, l'rc-School and School Service.• and ln­palienr Services. all impact on the health, development and wdl being of the child and the family. The growth tn-nd in 1hc btr<h me and rhe performance indicarors associated with the Rc:gional Marernil}' Sen~iccs emphasise the need for continuing support and resources to enhance 'early life' -ervice>. Child care Jnd prorecrion, while demonmaling a high level of effi!crivene.ss, 'cill has ,t '"'rics of concern< in rhe range of provision, e.g. ~hildrcn wirh parricubr behavioural problems J..nd mappropriace m·patit:m J.et.:.ommodarion.

l'cr<ons wirh learning disabilities ha,., expcncnceJ the benefitS of increasing invesrmenr in Rc<tdcntial and D.1)' Gre plate.<. 1 he"' ate' still gaps in service provi<ion. particularly with grearcr long.cvir). The li"'·'!l'Y l'roj«.t woll, on rime, improve <he re,ourcc ltvcl. The n<eds of those on.tppropri .. dv pl•ced in p>ydtiarric ho,pi1ols rue al~ being •ddrcssed During rhe larrer pan of 1'>9"' the lloJrtl fln>li~ •n agreement with rhe major agenc;es rn tts area described in 'Enhancing the 1' . ..-lnc"l"p' \in« l<thnuary 1998 funding;, being provided to them by the Health Board.

MC'nul Health \crvic.;.<"~co ;ue progre-~'\ing (0 J maturer ~fagc of <llterncnlvc car~ in the community. Capi1.l in~nment has been >In". although a nun~ber of significant projeet.< Me underwav, panicul.uly in the CIJn: arc;~.

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Addiction <ervicos and the development of Old Age l'rychiauy are rdarivdy rcccm inpms ro the range of servi= on 11ffer. ·rhe latter is unfimun:uely confined to rhe Limerick area.

Pe,..on., wirh phy>i<:ll ~nd ><:nsor:y disabilities :tre the subjeCt of an increasing awareness of the need for improved focus on rhdr m:.:d for cqualiry. integration and the general enhancement of the qu.tliry of rhcir livts. While tbore ha; lxxn an improvemtot in the provisioll of remedial thet:lpits. an urgent re>ponsc i> r«1uired for the Young Chronic Sick, a needs database and att improvement in p.trtncrship between scatmory and voluntary agencies. c:.trcr. and disabled persons. The appoi ntmcnt of a Regional Co-Ordinator and co-ordinating commirtee during 1997, wa.1 a first step.

Primary Care Services require improved linkages internally and with aU pans of the care system. Titc Primary Care Unit is workh1g toward> cl1at and it also has objectives related to the qualiry of pratriCl' devtJopm<.·m and rhe inr.crfacC' issues wirh Acute Care, e.g. prescribing practices in bo:;pital" aud their impac£ on commun.iry scr\'iccs.

MAINTAII'IING FOCUS

DeruaJ Services acriviry indicates an improving invesrmenr which is being subjccrcd ro derailed ev:1luarion.

The cn>t of dem:~nd lecl scheme<, which now include high tech medicines, is problemaric and rc.quii·es careful moniroring :.tnd teview. The non-funding of a signific:mr ponion of rhe cost' by year end 1997 by the Deparrmenr •·e.<ulred in a significant deficit iu the Board's accounting posnu:m.

Conununlty \XIdf~r< Services r<>-orienration 10 quality managem<m ha.< been assisted by irs involvement in the ISTS projecr. The Money Advice and Budgering Service exrension arises from. the real value of this intervention and supporr sy;rem.

Environmen"'l health is also a team effort wirh other agencies. There is increasing empha.1is on food safety issu.,.

The torcgoing overview i> incomplete without reference 10 the growing number of rcscarch/tvaluation projeCts and qu;~lity initiatives being undertaken by staff in many service settin&'· At rlus >rage the Board has three ISO awmh with scver-•l others in pro<:ess. Quality and outcome> projecu. re.carch based chang., in practices for all and learning through reflo:rion ore key ingn..-dient) in provi<.Ung beth:r service.

I wish <O thank the Bt>ard members. stafF, volunrary organisations, our ><:rvicc provider>, the Department of Health .tnd state agencit> for their >Upport in embarking upon a cbange proe<ss to deliver bcuor service> !"or people.

Stiofan deBtirca Prfomh Oillgcach Feidhm<'achain

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Annual Report 1997 8 q J 11

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CONTENTS

8 Board Members and Corporate Team

10 Populatoon Health Starus 15 Public Health 16 Health Promotion 20 Choldren and F amihes 25 Women's Health 27 Promary Care 31 Commun•IY Servoces 34 Older People 41 Mental Health 46 learnon& DISabohtJeS 49 PhysocaVSensory DosaMmes 51 Acute Servoces 60 Corporate Servoces

The Members Of Our Board

Elections for professional r<prelent>ll"'' of the Bootd w.rc hold in June 1997. The followiog """' dectw Dr o • .;d Oineh. Mr l'aull\urkc, Dr Muy Do""'""· Or Mary Gray. Ms Ann Ktnny Rpn. Mr Ltlm McNamara, Mr 1im O'Mall<)• and Dr Joseph F Lem .. ll<)'· Dr lim Ca«y and Dr Richard O'H•hmy were appo1nccd by the Minincr. Mr Brian Coweu T.D., to casual vac.,.ndcs- whkh h:td arisen dut: eo an uuulfKicnt numhcr of oominees for R.gisttml Mediall'nctiuoner. cnr Mu~ \ ·bnnion. Mr 0.-od McA,inchey >nd Olr jolln OiiTord "'""'nominated to chc Bootd by the Mllli,rer.

PAUL R081NSON Dqx. CEO Acute Sctvi=

K(VIN KELLEHER

Direa.or ()r Public H~Jth

G£RRY iiC KAIIARA

T t<b n i<>l 5<-tvi<-. Officer

Care Group Directors

MARY HEALY

RA:soon.J Co-OrdorutiOr of s.Moes for l'c:noru 'kith Dltabilttio

MARTIN OU FF Y Asst. CEO Cummuni<y C.rc 0cpt.

JOHN 8YRHE

Penonnd Officer

TOMMY HOURIGAN

M.m.agemem Stn-ic.ec Otliar

GER CROWUY

Oi"""or of Chikkvc •nd Family SupponS..V-

Mld-WFs.tern Heat Board

Ou r Corporate Team

JOHN 0 BR IE N Asst. CEO Mm..J H..Jth and Ekkrly C.rc S.rvkcs

MI KE TRUELOVE

Fm:mcc Officer

Communications

MA~ Y HAlPIN

Communtaftor~ Off!Ctr

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Population Health Status 10 11

Strt i1111 011t ANNUAL REPORT 1997

The Mid-Western Health Board provodes health and social servtces to the countoes of Clare, lomenck and North Topperary and the county borough of Limerick. The area is a moxture of urban/tndustrial around the Shannon Estuary and a large rural area. The Mid-West eXIends over 3,000 square mtles whoch, wtth the heavy concentration of the population around the Shannon, means some of the poputatoon are stgmfocant distances from major health facohttes.

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THE POPULATION

The 1996 Censw showed dte highest ever popularion in the region since the Sr•tc w:~.< formed of 317,069. Whilst the region cxpcricoccd an increase it \QS the: third lowest incre~e in !ht country tU q wh()lt.

One interesting ~:uurcr Qf chc n:gion i$ rh:n tbc nwnber of mai(IS CX(,"«d.\ tln~ number of female.~ - ll rc\·er.sal of the normal positjou. Fig1,1rt: 1 shows .;ht c;Omp:lrison of rhc pOpuh~tion of variqm ugc group\ in rhc 1991 and 1996 c.,lSUS. Figure 2 shows rhe splir btrween men .&nd women for 1996.

Fig I : C<>mJ".ri">n ~'«" rbc 1991 and 1996 C'..en.<us iTorol population]

• 1991 0 1996 0..14 84,134 75.880 15-34 92,8U ?7.98<) 35-64 97,106 10),720 GS..- ~6.675 37,480

Total 310,728 3 \7,06?

Fig 2 : 11te data for 1996 by rhc same age groups bur for men and women

• Males 0 F.m.l .. 0.14 38.937 36,943 1;..34 50.218 47.n1 35-64 53.848 51,690 65+ 16,440 21,040

Total I 59.625 157.444

Theso fi_gu~ show tltat the Mid· West increasingly tu. an adult population, with a slowly growing elderly populauon. rhe s111all growth rn rhc elderly rn»k.s a 22% incr"'se 1• he <- b f 85 . - n ' numocrs over r: cage o - a SI'Oup who are pamcuJarly <kpendc:m ou l1calrh. nnd s.t-.cia1 services.

Another fearure of the change io population bttwecn the 1991 d 1996 C'~nsu.ses is the cominulng movemcnr Qf the population i~t~ urba.n areas e.g. Limerick, its suburbs and Ellnis.

• The AI.<I-Westem Hellltfl Board Reg.oo llme<oclt. Clare /ll!d Tipperary N.R.

MORTALITY

One of (tte v.-ays or de..cribing rhe heahh qf a poplllacicm is tO loQk .;~r r~e JX!UC::rn nf dt:::nhs in chat pupu.latic,>n. The lvfid-Wt:st, like the rti"t of 1 reland, has ~ten a.n impro\'ement U1 tbe uwuber of aiJ age deaths over che ~acs. lndced wheJl acrounr is cakeo of chc agt smKrurc of the population, as Figure 3 shows, the Mid \X1csr h.ns shown a gi"C'Jtcr improvt"mc.nr rhan. rhe resr of rh(: country over rhe l~st 15 }"C.'lrs.

Fig 3 Mortal icy G'Om all c:auses A~ St.oncl.ard de>Alh m~" ~r 100,{1()() porul~1iq.n for 11 11 ~~. S year flm\'ing. \1~~ng_a:o;: H>8o 19'<)5

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1900~ '80-'84 '81-'85 '82-'86 '83-'37 ,·84-'88 '8')-'89. "SG-'90 '81-'91 '88-'92 '89-'93 '90-'94 '9J.'<JS

UnfOnunarely the same cannor be sajd when jusr the deaths uudcr the age of 65 arc looked at. ~ihilsr. like rhe aU ages death rare,.. the rare hOl.S fallen over chc 15 year period cbe position for rhc: Mid-Wen has temJine.d the W(H'St :1cr<),'>.'i the J 5 year pc:riud (Figure 4). Thi10 is shown in a c:lifferent way Ju FisuJe 5 which .shows dtal a person Lfl 1.he Mld-Wt!st is 4% more lik~ly to die bd'ore r.he age of 65 than the avcJagc for Ireland. Figure G shows m is in more detail for me pans of eh< Mid-Wcs1. Clare ha.s a rdorivdy good pieture wich a 6% less eh <"In~ of dying before the: age of 65 rh~n the ~vef;lge for lrel~nt.l whi1st both Nonh Tipperary ami Limerick have a greater char~ce of dying with people io Ume-rick being nearly 10% more JikeJy CO die before me age of 65.

Fig 4 l'remamre mormlicy from all c:msc:s 1\t.;e 1o1:ambrJ deilb r~ccs per 100,000 p('lpub1ion 0·64 yt:u,s,.; yeu movin:s a\'i.·~: 1950--199)

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Fig 5 J'rc:m:.uure n)ortality from all ea~ _ I•)HO--l99S Sund:udisul mon.<~bty Dtio pc1 100.000 f'OP\'b.110U ~}'OD-.\ year M~I'I'U\8111<'~-

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Fig 6 Mid-Wern:m Heahh Board premature 11\0rtaliry from ull e>u5<S Sutnd:ardl\t.-d ml)l1.i\llty ,..,uio rer 100.0()0 p<>pubtion 0-64 Jt~A. S ~~ mtwint a"'<r~ I ~&0.- I 'I"~

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The main causes of death in rhe rcglon are shown in Figure 7. Two third.t of all deaths arc :uxountcd for by heart attacks, mokcs and c;;mccrs. Wirnin the Mid-West1be picture is replicated for each county but a number of key issue5 ~re imporronr to no(t. The r.ur of de.ldu for unc.lcr 65s for circul:a:rory di~ is high f()r Limerick. whilSt the r:u~ of dearhs fmm injuries ls higi1 in Clare.

Fig 7 Main """"""of de.uh of Mid Western Health Bo•rd IV:sidcnts of all 2gi'S in 1995

• Respir•tory l>iscas.s 16%

• Cancers22%

• Circulatory Disease 45%

• All other causes 17%

!he t\~d-~CS~ has some of t~e ~tan~ worst bcaltb cxpcricoce in the COUntry. Whil$t (urther investigation as req~u·~d. u •; cle:ar that acuoo 1.~ fal\uted 10 atta:ck the: causes of this probl.em. Thi'l will require ~etion on smoking, exerCISe, alcohol and bl()()d pressure scrcc.ning.

AI d We ' He a 81 d

Public Health

SectiOn Tu•o ANNUM REF>ORT 1997

During 1997 the Public Health Department conllnued to consolidate after Its creation on 1996. Additional staff were appointed which aided some project work.

The investigation into the Human Health aspects or the Askeaton Animal Health Investigation continued. The Board's contribution, undertaken by the Public Health Department, JS part of the largest mvestigat1on into a potential environmental hazard that has ever been undertaken in the country. 1997 has mainly seen collation and analysis of data from the main health survey of over 2,700 people as well as surveys in schools and of General Practitioners. A result ol the poor quality or lack of data has often meant that information has to be sought from the anginal paper source often onvolvtng Jookrng at 20 • 30,000 pieces or paper.

Two other maJOr studies were undertaken in the areas of alcohol and drug use. Both of these mvolved large surveys with nearly 6,000 students being involved in the drug survey. Results or both of these will be available in 1998.

A review of access of the elderly to care and of the overall health of the elderly was done. This showed that whilst the elderly in the Mid-West were not as numerous as in the rest of Europe, the health of older people is worse and our provision of non-residentral servrces rs poor which makes residential care often the only alternative for an older person.

Finally, a major project during 1997 was the beginning of putting together a health profrle of the Mid-West. A substantial report was presented to the Board wtth the previous section on population health status being only a brrel synopsis.

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Health Promotion 16 ' 5 17 9

&rtiiJfl Tbru ANNUA~ RlPORI t991

STRATEGIC OBJECTIVES

The purpose of Health Promotion IS to encourage and facll1tate health and social ga1n for the whole popula!IOn of lhe M1d·West. The long term a1m of these changes is to improve the quahty of hfe of those most depnved and thereby reduce mequahlles m health. Success w111 depend upon sustamed Involvement and long term projects.

The key role of Health Promo!IOn is to support etrecbve health education and health promotion achv1t1es tamed out by those 1n d~rect commumcation with the pubhc • mcluding nurses, doctors, paramedics , pharmac1sts, dentists, opticians, community, youth and social workers.

The Board's Health PromotiOn Centre also supports the development of alliances between professionals and agenc1es to tackle ma1or health 1ssues such as the reduction of alcohol and drug-related problems or the promotion of phys1cal activ1ty. Such issues are managed on the bas1s of where people can be accessed · workplaces , schools and colleges, primary care centres, hospitals and the w1der community. The beneht of this approach is that it leads to a joint identification of needs and pnonlles, serving both parties.

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KEY PRIORITIES

Experience shQWS rh~n a p.annership approach i.s crucial to cng;tging commruUcics ro improve tl1tir own health. Cosnrnu.nicy puticip:ulo.n lllows people ro hav<' .l murt! Utfluenti:tl voice in ideruifying their htaltb probJems. deciding how ro work wirh sr.trutOI)' organi~3tioru J&nd de\·doping a grearer degree of pov.tr and control over rhc condirioos wbich :Ufecr their Ju~alt11. The rxpe:rieocc and knowledge: of communities 02n

m:ak~ the planning ~nd ddi"ery ofhc:~lch prograouue.~ more rdcvaot and appropria~. The rrt::tjor focus i~ on collectiv~ chaogt. whid\ is be.althwenhaucing it its QWn righr.

Tilrgtring our mosr deprived and disadvanc<Jged communicies is not like!)' to le:1d to fQpid he:llth -c<rains. hut waJ in the .shorHcrm improve rile- knowlc:dgt> and skill'\ a\'tlllable to <;:ommunitidf. Thi,. involvern(·ut wlll in 1um help [he Health Boatd ro set ptloricies and dr:h\' ~P hc:altb pl.an.~. Involving loe.-~1 groups is a olrt

element or comc.mporary health. services aod many of our .suaxegil! objeaives ClllnOt b~ n1et witholtt ell'ecrivt public: involvemc;:nr.

Tbc cm(-rging role of the Health Promotion \..cnt~ in supporting community dcvclopmtnr :tppco.tches ro He.1lth Pmmotion is:

to receive and gsvc information on hc:.1hh i.Ssu~. service prov-ision and gaps in secvittts. to provide support, resources and links ro other planoing srructurcs or re-ams. ro help sec up new nt~worb and produce briefil'lgs ror poJjcy dcvdopmenr. to organise uaining in collabor.nioo with local g.roup.c:.

· ro encourage rhe involvemem of g.p.$, public health nurses ::tnd primary are gen<=rally, io undtrt::lking tommuoicy dc:vdopmenr appi'Q3chcs.

PROGRESS IN 1997 - -

The most signiilcant projects iniriate:d o_r da·elop<:d during rhe year were:

education for health

Compl~t1ng the Bl Follain .sc..ries. priming 1.500 copie.c; of the fin;al manua.l and dissemination to all primary schools in the rtgion. A..isring wi<h thr launch of the Hcolth Promoting College at Maty lmm:wulare College. Developing a ""'"'!lY oo physical activity for all Health Bo•rds. Running Uftwise cl~ in the: community and supporting tutors. Supporting the Red Ribbon Pr<>je<t, the loc:alagency for HIV/AIDs prevention aud the promorion of """"al h.-.lth. Providjng public tducation through lu01l radio and ntwspapcB. Supporring the Clacehavtn House Outrea.ch Project on doo1t~s1jc -violence iu ~'esr Clare:.

child healt h promotion

Providing tr.1ini.ng for prima.ry schools (m 1\cdoo for Life' whkh protnoc•s pi · 1 · · . . , . ... ')'Sica ~cnvuy. Hdpmg to develop a smttgy on brca.nfe<dmg and organising rr.aining f<>r Heal h llo· 1 . .r C ·•· · d · · · r t "" S{an. c-orv•naung :Jn supporung uacnmg 10t partming programmes and evaluating our provision.

cancer and he art d ise ase

- Providing supporr to Europea11 Cancer Week and lr.ish Heart Week. Dcve:lopiRg public awareness signs with Clare County Coundl for .skin cao{'((r prc.vel)tion ol)d pmte<;t\on fnun harrnful elCpown:: f(l ~wn.

o ld e r people

sub stance misuse

~ Providing crainjog oo 'Drugs Awareness- Lo~ll\nswcrs•.

Suppcming $tT)oking ce.~cinn programme:.' and rt'-dc;.-.ig;ning puhtidty ~d educ.-uiunal materials. Steering lhe R.egior~ Drugs Comrniuee.

~ L tunching the G.l\ .• A...sponsorship and maintaining publiciryJcducarional inpur oo drugs awareness.

trai ni ng and education

- Oc .. ·doping a djplNma/rnastcr'S in ht:alth educ:n.ion/lttahh promoti«)l1 and ~vaJu:ulng previous courses in social and heallh edocatio11.

- Pro .. ·ld.ing a full programme of profcssjonal devclopmcm including a three day founda:ri.on course in hc:alrh ecJuq~rion/he:tlth prom9ci0n for Health Bo:~rd staff.

- Pl:mniog and presendng at a.be U.C.G. Swnmer School conference.

nat io nal l y and l ocal l y

A J>articiparing io f!.·:uion::-1 stn~rcgy groups Oil smoking, accidems, Jife.o;tylc ~urvcy.. ere. (Jgising wltl1 linlerick Wrp<H:ilion 0 11 the provision of public hlfOrrnalion poi.ocs and the possibilities for a H~lthy Cities init.iadvc.

Righr: samplr pub!icationr )Tom 1997 promt~tlng inrTY4std pbytit:a/ attivilJ Ulld t:or!Jn-r~~t~ matn-ial (Jn shariflg gt>Od pmdi«

Mnr11 infommtiim lrajkts tunt' produ£·t'd ID cowr uuh roph:s as Stop Smokiltg, ""''*"'x Tog<tlxr w makr r!J< Mid· ~st Dntg FTW Dnd Nralthy Etuing choices for roday..

1 2 3 n ;; 6 7 8 9

lO 11 12 13 14 1& 16 17 18 19 20 21 t!Z 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 411 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 &4 65 66 67 68 69 70 71 72

M W

Children and Families

&-rlion Four ANHUAL RlPORl 1997

Ch•ldren and Fam•hes have access to a w•de range of health and care services provtded by the Board, •Is partner aaenctes and voluntary groups throughout the reg10n. Servtces provtded by the Board for chtldren and fam•hes a~m to ensure that each child reaches hts or her maxtmum potenhal m a sale and nurtunng envtronment. There is also a range of support ser•ices for famthes expeuenctng dilltculttes.

CHILD HEAlTH

strateg1c ob1ectives

The nnt<19" obj«UYCS of the Chokl He>lch ~rvoa: .tte:•

- The p,.,·•nuon of olln.,. or.,....,. through Health Eduation/Promotion. · To ofTtr survt1llanct and health cnh;anccm<'nt opponunitics .u ante natal. post nalal. pre·-.ch(M)I .tnd

school c::uminauont. · To emun: 1he implemcnt~uon ur rec:ommencbuons and urgc:ts outlined in the Ocmal Ha! rh PlJu.

lrnmunisarion l'rogr.1mmts.. NationaJ Working Group in Bacreri:aJ Mtningiris and the Working Gm'-lP on Tuberculo ... is.

4

20 21

key developments

A Chold llcoi1h Sonugy Group,. .. , oublo..hcd 1o rormubt< • ""'1£ID. for chiklr<n. wluch v.iU be

pubhshed in 1998. . . . . . A rompou..-is<d child rq;is<cr 'Y"'"m,.... oubli<h<cl on 1997 v.hich r<rords Ullmun,..uon• and grncr.ue> 1tpt>m and pa)-mentS to gcn~nl pratt1tWncn. . . T

A Breasn«dmg /lnfam Nurrit:ioo Sun-ey was cundu,ocd by l'ubloc Healcb l'un<S and • '""<'llY 10

promore brea.<ofeeding in rhe Mid-Wesr w.s publo>hcd on 19')7. lniri;m('ln nl Mother -and ToddJc:r Groups and Mother and lnf.1m Croup.~. 1\lrcntlng courses and courses for first cimc: mod1c11 ~nd ~ill~lt p:ucnts.

Br~tfeeding >llppon groul?"· Communit)' Mothers Prog.rommc:. , . . . . .. A survey of Child Dentll Health W'.U tondumd '" 1'197 '" CORJUUUOOn woth u.c.c. The nnding.' will

be publoshcd on 19')8.

emerg1ng 1ssues

A Workong Group i< cnmining the .-1 for l<f\l<r link.age. be<wc<D Child Hellth and M.ternoty Se"""' to cn<ur< !hat information tr.u>Skts wicb the chold .a..n»> I<<Vi<r bnundvi ...

The omplcmenurion of the Childhood lmmun,..uon Scheme h>\ <><pcrieneed difficultic> on ohe r<portong of the uptake or immunisation.

b tr ths

There wa..a tot•l of 4,765 birtlu in the region in 1997.1 hi< was a 4% incr.._,. on 19%.

school med1cal examinations

42.118 children had th<ir heat:iog and vision .cm:oed and tbcte "~"' 51.378 denul :urendanccs.

The U>.lg<' of the children's den121 .rn·i<r is on=:uing each yar. 11te number of 6lling> and fu.w.., .._.t..nt> " incrasing. wloik numben of m><orgmC)' mmd.tnco lw ckcrased

CHILO CARE

Services for childrt-n and fiunilics can be broadly grouped into rhrce inter relat~ se.rvice ar~~. i.e. ComrYiunity devdopmcm ~nd family ~~lf.trc scrvi1.ct. The\c sc:rvia:s assist communidc:s to ideruify a.nd pl111l rcsponseli m their own neeck Child and family protection and m:aune:nc scrvi~. Thc~c art d~ig.ncd ro promote posiLlve cart of thllt.lren and provide appropriate trc:&tnlC:I\l .!.<!rviccs JJ r~uar«l. Altcrn.uivc arc scr.io::s 'Ouch as adopcion. foster ;a,nd r1t1idcnri~l carr.

The II>IUtOI'} f,.mework for child an !ittVOCU iJI~ Child Gore ht 1991. This hi recognises tha< the ':''"lf.art' of tht ch11d ts of lhc utmost im~rwkt and n is in h1~ or ha but interesl to be: brougtn up in .a f.unolv en"ronment wlo.:rcvcr pos.ibk lbc l:loanl fully AIJ'POrts thc:sc principle. and works doody with f;amihn. (ammunittc\ ;and other ~~a 'o ac:hinc thnn.

strategiC ObJectives

ro tn~urt' thar ever} child gTW') up in ' We. nunuring environmenL fc) tn\U((' th.;n ~rviet"S Ut a\'~ailabk_ 10 thOK «p<:ticncing d1ffiwJtics io their personal lJ.,.·Q and rctuion.,hips. Jb rronwte fht41rcb and cvJJuacion of K:rvi~~.

Community Care Area

Child 1'rutc:.~.•rion Rc.(~:rr~ls

Children ;,, Care Re<iden1io.l llll2/97 Non-lksicknclal31112197 AchuissiOJ)$ w care 1'997 Di$<.h~~~ from C:lt'e- J 9,7

Ugal Acri"·i()· f.,)lt(~n<:)' QJc Ofdccs lnrcrim C2tc Ordert ~Orders

Suptrv~slon Orders

KEY DEVELOPMENT S !997

add it i ona l fu nd i ng

Limerick

336

14 179 215 227

5 s 30 21

Clare

268

6 90 116 112

2 2 8 17

TIJ>P N.R & East Limerick

11

92 99 103

2

4 2 6

Total

31

361 <00 442

9 ll

40 44

AdcJirion3l fUnJing wa.-. provid~d during tlte year to Strc::ngtbeu m:.tnas~menr StJ'UCtllrts by: <he appointment of a regional Dirccror of Cbild Care and Family Support Services. <he appoimmeor of Child Care Managers in cacb Community Care Area. lnspc:c;r()r.tte fi.mttion.s we{c estahli.$hc:d in 1he pcc-~h(>ul and rc:sidential care settors

s er v i c e del i very was i mproved by :

incrta.~ing night staffiog levds in residc:nti:al homes and upgrading lhc: fire prot~ion and dt!tecdon system .. ~.

providjng accommodation for :access visits by parcnc; eo chclr chjfdren in care. - i n.cr~d paymeots t~ fmt~r care~.

- c~repding c.be faJ:nily Therapy Service iJl Li~t~erick and Nen.agh. - appoinriog a Pre-School Services Officer in June 1997. ~ appoiJJtiog rhrec ceams. t:omprising of a public:: heotlth nuf'$(' and :m ~m;ronmenul health offic~r to

inspect pre-school$. building work commenced on a cicy cenue day care/prc~school facility with limerick Social Service Cemrc and rhe PAUl . Pmnership. opening a resour« cenrre and supported atronunodarion for vulnerable lone parents in a.~ciation wirh CURA. complcdng the region-al chjld protcaion guidelines :3nd undcrrnking an asscxi~ced ~nulri-disciplinary and inter-agency rrW.ning progr:unrne with Community Care $t:aff in tht' region~ publishing Safe Care an Foster Care Guidelines in conjuocdon wlrh lhe Irish Fosrcr Care Association. revjewing the Case: Conference system.

- providing addici,mal FUnding eo ADAPT H9usc:, limerick, Limerick Rape Crb.is Onrre apd Clare Haven Ho~ to help dte victims of domestic \'ioJence.

- app1oval \YaS rccdvcd ftom Comhairle na n.Ospidcal ro che appoimmenr of a second Consulrant in Child Psychiorry funding was .1oecured to provjde a pennanent facility for lhe Adolescent Boys Service .and tu expand the Hosrel Service for homei<SS adolescent girls ro include • dJop-in e<nn<.

I 2 3 1 5 6 7 8 9

10 !I 12 13 !4 15 lb 17 18 19 20 21 22 23 211 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 ~6 '>7 58 59 60 61 62 63 M 65 66 67 68 69 70 71 72

r esea r ch

The University of Llmecick was commissioned ro c\ralu:tte the NadQnal Parents SuppOI'I Progrnmmc (Community Mothers l'tojm)" cl.e end of its thn:e ycat pilot phase. The "'POrt rtcommended continuation of chc project.

The ('..h i.ldrton~s Ce:nuc, li"inity CoUegt. Dublin w.as engagr:d to review alrtrnarive can: services: for cl'ildren in <are. This will form the basi< for a srrai<gi< development plan.

outcome studie s

A study of the Child Ptotecrion System was underotken in partncr<hip with Univ.,tSI<y Coll.gc Cork. This projca tr.a.clu:d 300 noti6carions m<Jde tO rhc Board during-a thtte month pt:riod in t99G. Phase One =blish<d the C~>ur« of :u:tion taken by •ocial worker• in each insrance and was completed during 1997. Phase Tv.'O, involving a one year follow up aod incervie\\·.s wirb social workt"rs and a random sdenion of clients. wm be completed io 1998.

A research project w:u i1ait.i.ated hy th~ IX:parrrocnc of Child Psyth.iauy [0 examine cbe source and reason for referrals r«:ei .. -ed from limerick City.

The Bridge C<>nsultancy Cro<>p (U.K.) undertook an evalu•don of the Family ResoUKe Centre in Moyross which was emblis.h<d by Samardo's with the suppott of the Boanl.

eme r g i ng i ssu es

The lac:k or restdenrial care for r;hil<I.Kn with partic:uhtr behavioural diffiC\IJries conlinuQ; I() be of nl«jOr conce-rn to tbe Board.

Tht l~c~ of an our-of-hours social work servkc is a cause of seriou~ concern and is the subject Qf national negooauous ..

The in~pprc)pri:_atcncss of in~p~dt1u f.1t:~itics ~dUsed hy the Department of Child Psychiatry poses problems. Adolescem$ rcqumng acute m-pauem care are admirred tO the adult Acute Unit. SB Regic)nlll J Jospilal Limerick which i$ un~tisfactory. •

M!d·'N~ reo1 He<JI(h Bod~d 1 2 3 4 5 6 7 8 9

I 0 11 12 13 14 J 5 Jb 17 18 19 ?0 21 22 23

Women's Health 24 25

s~cltim Five AN NUAL RE PO RT 1997

In April 1997 the Department of Health published 'A Plan for Women's Health'. This followe.d a major consultation process with women throughout each Health Board area.

In recent years it has b.een recognised tha t women's health Issues require particular attention because of the varied roles which women play throughout their lives. Issues wh1ch particularly affect women's health mclude:-• reproductive role wh1ch exposes women to particular risks during pregnancy and childbirth · roles as wife, mother. 1ncome earner and carer which take a heavy toll on their health . • economic dependence and poverty affect women's ability to make healthy life cho1ces . . exposure to violence and abuse which may damage their physical and psychological heal th . . longer life span which may mcrease the periods ol dependency and aloneness in their final

years .

In September 1997 the Chief Execut1ve Officer established a Women's Health Adv1sory Committee to develop a comprehensive and inclus.ve plan fo r women's health 1n th1s Board's area.

The members of the commttlee represent a broad spectrum ol orgamsations and servtce providers working tor and wi th women in areas allecting women's health.

/b 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 % 47 48 49 50 51 52 53 'i4 55 5o 5/ 58 59 60 &1 62 63 64 65 b6 67 68 o9 70 71 72

The Advisory Commina- lw o;tabli~hcd l\\-'0 sulH:omrnmro on mform.uion and tomu_1Uik)n tu idc~c·t)· I · r_ rd · ~ndln• to wom<:n"• ooo:d\ » i<knnlicd thn>ugh the uonoulwoon

t lC most appropn.;~~ w01ys """''"' an r-.--- -~ pr<>CtSS.

'I he infc,mnatlon sub-c;onunlw.oc will idenrity the type of infOrnHnion requirc:tl and the rnost innov.au\'~ wa)'J of dissaninot~ing tl.

f'ht- oonsuh:atioo sub-corn m in« will identify th.c= mon appropri.ltc vny ro continllt' the con<oluuvc

P"'""-

DEVElOPMENTS

Tht Board has hem t:h())ol.:n 10 undtrakc a pilot project in ttn'K.:al anur Krttning u p&n of the comtxuing di.~ prog~mmr om1iucd in the plan.

The services ar rho lt.:gion•l M .. erniry Hospi<al have b«n Jo:vcloped and unproved •• v••• or I he Bo:ml's 3ppr«tch to thi& llr.,:a of womco•s he:.h.h.

The public health nunong SCf'Vi..e P""'ides support <o ~ nw<hen in tbeor borne..

The Board cnd.muok a review of b=sUtcding practice> thooughour the «gion which wtll fmm the ~»si> of oaion <o imp~ upal.t rnes in the futuro .

• An agreem~m "...._.,. rcxhed wnh tht- Fa.mlly Planning Qinic l•mtric.Jc. <\nd t& Wdl Women Clin1c.. N""·c:m!e West ro provrde F..mily planning services <o people covered by <he goner.cl medial "'"'i=

During 1997 rhe Oq>:a• tmc:m of He:t.lth retcht:d agreement with general praccit.ioncrs to CXJland their f.amily planning se:rvkcs and chi.s w:as implemental thrQughOtu the rt:gion.

A project was commenced wilh &rnardos eo develop founily scniCC$ for \lo'()IDCD ln j pa.n.icul.u .w;a or JOci:d disad="'5"-

An educarioa sc:MCC in rdarioruhips !Or young wun>en "'" aabli<hed in Limerick Ciry.

A continence scr>kc: is oiTered through the public beal<h nu,.lng and physioth•"PY $CTVIC<.

The Report of the To<k Force on Violence agaiw" Wont<n was published by <he Ollk-. or chc Tanaoste in April1997. Thi; Board ha,, developed linbges with voluntary orgonimions in rhe r<gion including ADAPT, Limerick: Clare J·bvt-n, Ennis. and the Rape Crisi,: Cenrrc. J)nlc.tice guidelino and protOC()Is in rdarion ro this issue Y.-.:rc I'C'1C'archttl in 1997.

S<r-·i.::es under the He.Utb (Amcndmem) h< 1996 Wtt< provided 10 nindy-Ooe peopk (eigluy-four women) who h>d contrac1cd Hcp;wus C through the admini•tmion of Anri-0 and o<ha blood producu. Thc:i< ~rviccs indudcd medical. denllll. phonnxy, oph<halmic. cou..dlmg and home ltdp ~icc:s.. The fO(us of the Sc»rd's liaison ~is to cn~urt ~ chtnt focused respotue.

The llo:~rd oupponcd rhc ~rk of the Soroptomi<t> in Clal't.' in 1997 in <heir servicx• to corers.

Suppon was provid<'d to vulncrn.ble loot parent.s through a c:o-npcr:uh·e arra.t\gement with CU RA which provides c.ouMeUing .md :~dvkt services.

The R<p<>n of the C'.ommi<>lOO on the s .. ~ ... of People wnh Ol..biliri .... Stru~ for Equahry- ..... publi>bod tn 1?9.,. A U>·Ordmaungcomnutttt for ph)'>ial and ~nsory ~ilir:ies""' .,,.bl"hcd and .. at >dvuo the Board <>n prronr"" and dn-dopmmu ne<.....y to ruppott .. ..,mm with disobilirics. R<poru from rho daub.\C on lntning ~ilitics beam.: avarbhle in 19'17. Those will assist in tdenufying the rcspon<n n<C<' .. ry to de\..Jop sc"'ita fnr thi> group or women wi<h spccW nee<k

L~n :uraogem~n'' jrc undtrw.1y to devdop better scrvt'-t' ror and with the rravdliog comrnuoiry. l':uticulor ompha.,,s Will be pl•ccd on the health of uavdler women. ·rhe Board's pl•n for women:< heal rh will be published in 1998.

M1d Weste1n Health So 11d 1 2 J 4 ., 6 7 8 9

10 11 12 13 l ~ 15 16 17 18 19 20 21 22 23 ?4 25

Primary Care 26 21

AN NUA L REPO RT 1997

The aim of the Prrmary Care Service is to develop an inclusive, interactive process with all providers of care -including medical general practitioners, community pharmacists and dental general practitioners. The Health Board has identified the establishment of l inkages wi th all provider; ot care in the comrmmity as central to ensuring the health and soc ial gain of the population.

A Primary Care Unit has been es tablished by the Board and is staffed by medical general practitioners , pharmacists and administrative support staff . The role of the Unit rs:-

The provision of support for services provided within general pract<ce. The identi fication of . and entering into arrangements with, individua l practices to provide addi tional services where this could be done more cost effectively than at present.

- The facilitation of an improvement in the interface between general prac titioners, hospitals and other health services .

. The allocation of resources to fund the development of the servrce .

. To provide ongorng support to education and training projects ol relevance to primary care on an individual and project focused basis.

At year end 1997, 139 general practitroners held contracts wi th the Board to provrde general medrcal services to 101.635 people. There are 50 other general practrtroners rn private practice in the region . 189 general practitioners hold contracts to immunrse children.

28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 6<1 65 66 67 68 69 70 71 72

ISSUES AN D DEVELOPME NT S

PrcKribing puLilet\ 1n1pacr M OOrh ho,..ptrll.-.nJ 'ommunitr )Cn.~.n. :n•ia ~uirtl t;~•nu.:ant ftlollltori"tt •nd "'""' dT«tiV< r<lwon•htf"' ht .... ccn h<»p•l1l•nJ <ommuntry mC\loal uafl n...U ro h< <k-dPf'N

To d.tc, .£3 I milliOn h"' h«n m.ode .-· .. t.hk to S"n<r.d pu.:tK< .kl~lopnt<nt m the ~<>n dvuuch the: lndi<:uh·• Urup l.ug<~ Scheme. Fundm~ h.., bc<n '~""' on rh< dcvdopmmr of rrtmtJn. mNJ~ •nJ non-m«<iaa c:quipO"K'nt. communtamm' .tnd •nfvrm.~uun ccchnolozy.

community pharmacy serv1ces

n .. o.-p.runmt ofH.ahh ••d the Hralth S...nh "''" Cftl<rtd into an •srennrn• ""'" '"" '""' Plw-m.u:o.-ulk-al Cnion for eh< ~'">'"ion of Pharmx)- s.M.:n. und<r tht tk.alth 1\tr, 1'1"0

During 1997, the He.dth &:ud rc«i•C\1 .nd p~ faur "f'f'lic<luon• in ""~'«' <>f Commumtr Pharmacy C<Jnu.~<:tor Ap«mcnu.

dental serv1ces

Reduce the fcvcl of dc111ill Ji><J« in childtl'n. Promote the OVC'rall lr\'d or oral hraldt in rhc pol)tdation. llrovidc prt'VttUiV(' and rr~rmtm .<ervicts f(u children. spt:d.•l needs group:. and lduh mtdk.a.l t<trd boldct'>.

There is a high d<m•nd for tr<liOI<t\l undor tht Adulr Denul Tl'<3uncnt Service. S<h<n>< tOT:.S). The followi~g ublc illum:ncs 1~97 a~riv iry. ~mvi<ion of emerg.:ncy ueatmcnr ls high. but ltdudng..., • proporuon of cocal atm•hy. Thctt is ;an inc-rc.t41ing ttndt'ncy for Jdults wi[h medial problems or rtquiring non dent:a.J ll-.!.lllnc:nl ~rvke ircms lO return ro the Soot\~'$ dink\ for rratmcnt.

Activities J ?97 Adult;\

Episo<l<s of emergency urr

Num!J<,, of ttcrh ''"""'"' Nnmh<r of ,..,h filltd Numh<r of dcntUI'G rrovidtd Trwmrnuprovidtd

refund of drugs scheme

Non·DTSS

908 601 469

DTSS L 5,3'i I 9,106 6.766 1.383

23.290

Th., t<fund is pa)\lbk 10 anybody whos< _ , . . '6td ... . <Xptn<UIUr< (oncluding dut of dtp<ndon11) on prcscribcd dJU(l> on

asp= 1 "'""' monlh pttiod .,.C<>tds!9000 Th dcnu-' .. , · to <x>nuol .,.-..ituRc Tht 1...,7 ( · . · • """"" n:uure of this scbcmc limi<> tht <ap.>OI)'

1'"~ • n C.,.t o tlu,sch<rnewas£1.312m.

drug cost subsidlsatlon scheme

l11i~ 'Lhcme .:u.s.ish prople (who do not h . . long term 111t'die..l condition and I

1 a~ a rncdJc:al cud or lnng 1erm illness c:.ud) who have .a. ccroficd.

and mtdotinos. n •• 1997 ""'' 1 .. ,~." ar! ••• to pay more than £..~2.00 per month for prescribed druss · O t m 'ncmt was !4.098rn.

long term illness scheme

This .sdu:':me appli~.:s w people suffering from one of £he followjog Long Teon Wncsscs who are cnridc:d ro free drugs aod mcdidoe.o:; m~ntal llalldica~ mental illnc&S (fc>r p<:r.o<>n.s nndtr 16 only); phenylketonuria.; cysric fibrosis; hydrocephalus; epilepsy; acute Jeu.kaemia; O::J.ebi"'.LI pab.y. di.:thetes mdlltus; dial~tc:s insipidus; p:.trkinsonisffi! nmlciplc sc.krosi.s; haemophiJia: nlliSatlar dystrophy; The 1997 cosr of (b.is sdl~ote was !I.30Sm.

hepatitis C · hea l th (amendment) act 1996

Thts- .sclae:tnt appljes to people whQ l1ave .:Qntl':\czed Hep:.1ti1is C fmm the u~ of Hum;.tfl JmmWloglobulio -Amj D, \'('hole Blood or othet Blood products wltlti11 the b'Ul~. People eligible u.nd.er tllf~ s.du~me a~ cnridcd ro all prcsoribcd drug,<, modicincs and medical al)d surgical appliances free of charge. Tius emltlc.-m~nt t.; DQt means re..i·ec:l and digihiliry, which t;Ovcrs fhc: OIU(horised pel$0n (lnJy. ;tpplies foe [h<: person's lifetirne. 9 l people were covered b)' this sdu.•tne in 1997.

high tech med ic ines scheme

During dtc year. a scheme to dispense high t«h medicines through c.ommunicy pharmacies was put in place.

family planning and pregnancy counsell i ng

During 1996, fi>nnal agn:::cmenrs were rc::.thed wi.-h rhe F:unily Pbnning Clinic:'$ in Um~rick and Newt.:1stlc

West on a range of services to be provided for medical c:ard holders, whid1 continued during 1997. 11tese include coun.sdJing, medial care. medical and non mcdicaJ concraccpcives:. Ongoing discussions have been held. wid-t general medical flr3ttitione~ and other org;a.nis:tJ.:ions oo ensure rhe 3vailabiliry of family planning and pt'et;\fiancy counsdlins, This issue is bciug approachod on a holistic ba<is involving all >.>peers of women~ hcaJrb.

serv i ce performance

1lle sc:r\'i(;t: qhjtttiv~ to date has bec:n to imJllemc:m rhe propn$3b cont;Uncd in the: Bl~leprim Dncument fOr lhe De\'elopntetlt of Ge-neral PracLict. Durlng 1997, ~fforts were made to mea.fiu.re rhe a.chieveme1tts of tbe<e ol>jcctivcs under rhc following headings:-

Additic)tlal SeMces: an outline of additio•tal services being providal. Effect oo Ochc-r Services: establishing if G.P.s can achieve a grc-.ucr input imo hospital prescribing pr:t<."fi~.

Consumer Feedback: de\'eloplng a s-ysrem for local surveys. Cost Ef:Tcaivc- J>rcscribing: c:st3blishing a rransparcm audjr system. C.•re for Olckr Adulrs: idemitying specific proposals .

• Tmini.og Grancs: measuring t.he effecdveness of providi11.g specific gmnt.\.

qua lity initiatives

The dC\·dopmcnt or 3 Prim:uy Care Srrarc:gy GQmntcnccd in conjunction Wifh the Director of Pub1ic H""lth.

Developing and supporring qu:\lity assurano: projects within general practitc is of majur impnn:mcc. A qualiry assur.u'Ct' projecr Ln general pr.ac,ice commcne«i during 19?7 in coojuo<tio•• with the O..:p:mmcnr of Public Poli<')' at the Univt.rsity of Limerick.

1 2 3 I 5 6 7 B 9

10 11 12 13 14 15 l6 I 7 18 l 9 20 21 22 23 ~4 2' 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ·10 41 42 43 44 45 46 ~ 1

48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 58 69 70 71 72

information on presttibinl!> and consultation u.sjng the GMS (Payments) Hoard ~pordng system is ongomg.

Fo'-'r gc:n~ral pmc::rice trained doctc)f$ completed m ining in Jwte 1997. four nf\v trainees commenced lht>ir vocational training in July 1997.

Meedngs [OOk place with <XJ(ISuham medjcaJ smff at tht acute general hospitals ln the Boartfs rcgioal. lssua; were identified and "n acUon plan developed to improve the imcrfilce wiLh dtest! scrvita.

The Irish Cqllegt of Gwer.t l'raairionors (ICGP) Mid-West rcpr~nmtives bdd review :md planning meetings wiLh Lhe G.P. Unit S{ilff.

Unluge wirh the J'rofc..or ofGenor.U Pranice ar NUJ Galw:>y wa.• rurrher developed during 1997.

Discussions took phu.-e with lndividual and group practiti6ne.rs to identify rot<~ 01nd locum nc%tls.

Di:)cus.o;itm~ took place. wich the medic:~ I library $caff at Lhe Regional Hospital Limerick to ensure. continued relevant access for general pi'Oicricionen:.

The dc,·clopm.cnt of computerisation in general practice continued anti the ide1Hification of g~ncraJ pracciriollC:fl• n.ccdo; in relation to hardware, soltwarc -and mining w.as carried <)ut.

service initiatives

The following were undertaken during 1997:·

Discussions U>Ok place during the year with four general practirioners with the purpose of org-anising 3

gr<>up practice in Limerick City. The gencr.U praaicioncrs agreed • li.r of ~ddlcion;tl scrvi~ to b<o offered from the proposed centre. They have C)(pcric:nccd difficu1ry in :acquiring a suitable sire for the ceanre, but efforts arc: coodnuing.

The Derm:uology Outreach Clinic- conUnued during 1997 and Lhe large \Yahin.g list was reduced. le has f..tciliraced the rotation oF anendlng general practicioners and has improved access to services by patientS.

The J>rianary Care Unit, in t;Ommon with those of ochcr Heal rh Boards, was iJwolvcd ln chc Chief ~et..'lltive Officers' Group Sn;m:gy u) reduce: rhe inddem;e of sdf referral to A&E Otpanmc.aus. The Unit pronwtt:d rot:u, out of how'S cross rover and tb~ ;t\-al1ability of M.aturing :md minol surgial proocdun:s :u all GMS practices eo further this approach.

research

Health Promotion and Disease Prt"vendon. The Primary Care Unic is working witb rhc Director of Public Health and the Heal m Promotion Officer in developing this area of .sc.rvioe •hroughout the region. All proposals for funding of praaico dcvdopmcn< must indudc eviden<X of dis~e prevc:ncion and health promoriQn iniriati\'eS,

Claro Suicide Srudy ·rhi.s inidariv~. unden;}ken by one G.P. involves a r~view ot 1996 nnd <1 prospccti\·e study for 1997 ~o 1999. All G.P', in Co. Clare were surveyed and reports of suicide for '96 and '97 b~vc b<oen rcmmed. The pre)posal was discussed wit:h the Director of the Suicide Poundadon. Cork and the Chief Psychiatrist ar Our Ladt'$ Hospit-al. Ennk This scudy differs somewhat from the national study as the prim-ary source of il1formalion i.s the G.f~ r:l[hcr than tht' Card:ai ;md Cc,roncts.

Dental Services A suf\·ey of children •ged 5. 8, 12 and 15 yenrs w:u uodcnoken during 1997 ro ob rain d"t:• for ongoing monitoring, eo.:aluarion and planning pul'poses for oral bealth sentiet:s in the Board's area

M d ·Ne e I

4

Community Services 30 31

ANNUAl REPORT 1997

Communoty servoces are avaolable to all care groups. Theor purpose os to ensure the health, protectoon and welfare of the populatoon.

These servoces onclude:·

Communoty Welfare Servoce Envoronmental Health Servoce

~4 (i

!>!! 60 62 G4 6u 68 7

41 4 4 4 49 5 ~J

~ 57 5'l 61 (i3 6, bl 9

71

CO MM UNITY WEl FAR E SERVICE

ai m

The aim of the: Communir:y \'l'elfarc Ser\'Lcc is tO provide and dcli\'Cf a pn')anpt, accur:ue advic:c ~rvic:e with rdcvam n:fc~l ~nd payml!nr scran~glcs suited to customer needs, enabling people ro r~lve their difllculrics aod ro live rhcir lives in a dlgnifi<'d m01nner.

st rat egic o bj ec ti ve s

Tt, cn.~ure deli"ery of services is customer f()C.Used

The service rook part in :.1 number of C:ll.Stomer u ibunals org:misecl hy the Depanmcm of Soci31 Community and Etmily Affiti,. on Lone Parents and Older P<'Qple. A new appeals pr<>ec:dure is currently being developed and will b< introduced in 1998 for mo Community Welfare Service. Sotlf oontinue to pl:ty a leading role in rhe Welfare Rights Croup of the PAUL P>rmership.

To promote- uniformity in decision making

New regional guidelines wt:re i.ssued to community wdfurc office-rs in respc:<.-"t Qf dt:cL"jQI\S rdating ~o rem supplemen(S and ~x~uion:al 1\et!d payments. This- should lead to greater uniformity and consistency in decisions r·dating tO dL~;cretionary payments.

To set in place comrol mecbanis.nu to preo.·cnf fr.n.u.l, w!ISI:t' and abuse

New <:onrrol procedures for corn muniry ~dftltt: ..sufr were developed and implcme.mcd i.n 1997. Control reviews have now become an int~gral p-.ul of the day to day work of the communjcy wclfacc ofll...xr.

T() Strengthen service pannership with sratutory and community groups

An agency scrvi« agtccmem oudining roles :md responsibiliri~ of st.aff <~t :1lllcvds was :tgrc:c:d bcrwcxn the.'! Communit)· Welfare sc.rvicc ;1nd the Regional Unir :n d1e Dcpar1 ment of ~)C:ial , Community and F-.unily Affuirt. A produa of 1.h~~ agrc:c:ment W3~ 1he clevel_opmenl (lf a ' Handy P:ick' t() .streamline inv<.$t.ig:uion pr~~$ bcC\Yeell t.h~ agencles wich the objective or providing qukka and mort acturate respon.~ve decisions to the public.

The annual tnko-up campoign for the Back to School Clocbing & Footwear Scheme in cM junction wicb the local community groups was held in O'M.Jicy Pork. Moyross ond St. Mary's Park in Limerick City.

To complete the computerisation of the Supplemenmry Welfare Allowoocc Service (ISTS Project)

1997 s."v the comple~ion of the ISTS project in cbc Mid· West r<gion. 37 disnict~ ore now fu lly computerL~ed and 'live' (In the: $ynem sinc:.c: No\'c:mbcr 1997. A"-ess ro infonnat.ion and payment 5)'5tcms can IX' obtained <1t ove.r 100 centre.~ thr(.lughmu rhe region. This has resulted in:-

Reduced queuing at heal eh c:cnrres. f'"UStc:r decision making at local IC'\•d due to bener access to client rt'eords. Paymcm optiuns 10 cu~romer$ improved, e.g. dccuonic fuud uan.sfer. p0$t d rafis, cheques. Improved control medt.anisms.

M•d WP.;t rn Hf' l h Be

To funbc:r develop the Money ;\dvice a1ld Budgeting Servictc [hrovgh.our t.fle 1\tid-\'<'est rc::gion

The Jvfoney Advice and Budgeting Service has had considerable l>ue<.'ess in rel3rion tQ tl1~ original ai~llo of developing crediL opliu1l,.\ for lnw in~ome families. Th" service has helped families and iodi\•iduals iD\'Oh•ed to regain amonom)~ and .supporcs Lht»e .Struggling wich indebted(le&'l.

Thc- ft:rvice was ex-tcodcd eo rhc Ncnag.h area with tbe appointment of :t fUll fjmc: money advis(Jr .in Noven:lbe1· 1997. lt was :1 I.St:~ involved In drafting nmjonal procedures for money advisors in relation eo child procccrion issues and dealiJ)g wiLh i llt:~~al moneyl~11ding.

ENVIRONMENTAL IIEA LT H SERV ICE

aim

The Eovir<,mmenrnl ticalrh Servi~ llims m :!!.c:-hievc. he:~hh and social gain by rb.(" cnfon;cmenr of <'xi.sring healrh leghJ.uic)n :lUd rhe prOrnQliou o( pmre2nr-.uive health pr-Jctice$ in rdadon m food, water, :J;ir, hQu.-;ing, sa.nitatioo and safety ac place.s ofwork:and Jc..i.surc.

This is :t. (e3:Q1 effort im:oJving the: Health Board ~.1.11d ou~idt- agent:i~. The fVncUon$ of the Environme-nrnl Hc:aJrh Service are divided l>dween dutjes canied out on behalf of rhe Health Bo.ard ar1d those provided to local autbotities 011 an agency b:lsis. 11lc rradjdonal role of the c.nvironmencal bcaJrh service was focused co .. vards agency dtuics. However. eh is iS> c;h01nging due ro the:: im.TC.".lSed cmphll-Sis on food safcry i.sstaes- a.nd chc role of rht: environmcm:al health «fficer in regard ro tl1is.

strateg i c objectives

The objective of rhc:: servic.:t! is m enhance and protect public health. and. to that en-d, provide a planned 3ppmac,:h ro servillt' pcovision eo <."nsur<' <1 pro-2C'tive .se.rvict. This is achieved by pro,·iding food inspecrion an"d ~ampli11g- prog.rammcs and w;.lter .s;ampling programmes.

quality initiatives

The Boord has engaged in a qualiry as.~urancr: irtid:uive tOr the food comrol aspect of t:he servict under [he ::mspices of the D<'pamnt"nt of Heal Lit, wilh inpuc from the Narion-al St:mdouds Associarion of lrdand ~nd Promech Managl!menl Consul rants. Th<" inidative wiU c.levefop work protocols. a m:an.agenteut ~')'StC'm b:ased on ISO 9000 and a managtmcnr standard ttl which Erwironmeotal Hea1th Departments can be audhed.

The Clare Etwironmental Hea.Jcb Service imroduc::ed a policy of dc=veloping iniriativo to uckJe Food Safl!'t)' and Hygiene. The 1997 campaign Gt<getcd buteh<r shops (73). I< iowolvcd insp<e<ions. a S<minar for bu<Cbcrs 3J10 a programme ofm~r samplitog with spccial <mpha.<is on £-Coli 0157 H7. The campaign •im was the achieve:mem ofimpro\•emem.s in Food Safety through lns~c:tion, «lucation 3nd 'infurmation. This initiruive is baing an:ndtd ro aJJ parrs of the Mid-West Region.

I 2 3 4 !)

b 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2'i 26 27 £8 29 30 31 32 33 3~ 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 6! 62 63 04 65 66 67 68 69 70 71 72

w •

15

, 24 5 b 27 8 29

I

Older People 34 35

ANNUAL REPORI 1991

Concern for age1ng and older people IS central to the goal of forming partnerships 1n the care and support ol older people. As people grow older the11 needs may change and the Board os committed to providing a range of services targeted to meet the specific needs of

people over 65 years.

Serv1ces are provided d1rect1y through the Board's hospttals , welfare homes. mental health serv1ces and commumty services. mclud1na nurs1na homes.

48 4 SJ 3

55 57 5'1 bl

b2 63 64 65 66 67 68 69

71 72

the service aims:

- To maintain older people in digoiry and indcpendenex: lH home.. - Tl) restore to independence at home those older people who becom~ iH or t.ltpeodam . • To encourage ~nd suppon: the arc of older people in their own communiry by family, neighbours

and voluntary bodie.~. lo provide n high quality o( hospital and rc.<identi:!l care for older people when they can no longer remain in d'igniry and iodtpCI~dcncc -at home:.

A Stratet;r for older people has now be~n fc>rmally adopted by the Board.

The strategy is based on Thc Ctre condnuum concepr oudinl.-d in the: 'Revi~w oF the Years Ahead'. 'The scra~cgy cmpha.'ijses rhe imporr:ance of prevemarivc an.d amicip;awry care. home and community ~ate 11nd acute and long ttay ea~.

PREVENTATIVE CARE

he a I I h pro motion

A key demcm of p.rcvc:nradve care: is the promot-ion nf eont;inuin.g good heal rh. Healrhy ageing &s a part of all services, but porticul:<rly in the case of older people. The Boards He.Urlt Pmmotion Centre has adop<ed the LilCwi.sc Programme, a commu.rlity based progr·a.nune of exercise and bealth for older people.

There :ue 37,480 people ov<r 65 years in dte Mid-Wesr region ar dte 1996 census. Of these, 18,139 Uvc in Limerick Cicy and Councy, 11,656live in Clare and 7,685live in Tipperary N.R..

A!HtCtPATORY CARE

genera l practice and pub l ic he a lth nursing ser vice

General practitioners and public health nurses are kty p13yttl in the area of anticipatory care. l'he public health nurse provides nursing care eo older people~ fnunitOJ'$ th0$t who m."y be al risk and provides support for can:rs. They work closely with older people and are t.he link bc,wccn the com.municy and hospital ,.,rvke. During 1997, 3,709 people age 65 and over availed of this servkc. A funher I 1,710 arc being rtgularly monit()rcd.

HOME ANO COMMUNITY CARE

home help service

The homt hdp service ~a vi raJ danent of home care for older people. The SC"rvicc- provides oldc1 people with llSsistanc:e in the accivitie..;; of daily living wben a 1\ear rd:.u-ivc or family membc::r is noc :Jvailablc ro help with such activities. ln 1997, there were 1.131 hom• helps •mploycd, who provided 10,550 hours of home care, 85% of which was dedicated to older people Uving alone.

>.!id We .stern l leaUh Sr;Jrd

hou s ing aid for the elderly

1t is gen~raUy m..-qgnised t:hac the quaUcy of houslng -acrommodarion and prtWision fot older people ~an have significant ionpliation~ for dtcir heal m. The Specill Housing Aid for me Eldedy $theme i$ fund<d by t:he Department of dt~ Environmcn{. T his ,~h~me provides necessary repairs and i,mprovcmenr ro makC' dwe:Uings habitable for the lifetime of IJ'le occupam. At year e-nd l997 fhec;c wc:rc: 346 3pplk:ants t~waiting 3id uodc:r chis scheme. Average wairiog time from the receipt of appljcarioo to the col'nplerion of w01 k- is 6-18 month!. 250 applicmts bad improvcmeraS' and repairs carried our.

comm unity day centr es

Day care GeDUC$ for older people arc provided eirhcr by rhe Board or in parrncl;'hip wi<h volumary -agencjcs. The service ;md ~ctivhles prQvided by these ccnrrc.~ Vjries .. nd indnde~ recre:ui<mal. nursing :md a.~si::;tance with the :~etivitie.s of daJiy living. Tbel't> are J 3 day cent.teS in the Board~ area which l'3Cer for approximately 330 people pe,. day.

ACUTE CARE

reg i onal hosp i tal l i mer i ck, enn i s and nenagh general hospi t a l s

T he natufi' and <.luality of 11-CUR c.are provision tOr older penpiC' i.s ph·ot:tl i.n 1he context of the whole c:a..re concinuum. The bulk of illness encounu::m·l io life can ofreo be oonceouared in the lasr few years of life. This is reflccccd in the very high ~ranutge use of acuce care resources in the BoardS gttner.tl hoopitals.

AdmisS"ions fiJ r p~o_ple Olier 65 ytars eo rh,c Regional Hospir.al accounred tOr almost 29% of all admissions. c:<>ntra.<tnl with Ellllis (52%) and Ncnaglt (45%). Bed days used in the Regional Hospital or 4Q% is olso signilicamly lower than llvnil (70%) and Nenagh (66?~).

The ovcroll aveng< leugd> of smy at 6.08 day• '' 2.4 days shorrcr than the over 65 ye>r~ group at 8.51 daJ~. There were 6,1 77 acLnissions (over 65 years) to dle Rc-gionaJ Hospital during 1997 a.nd this indudes 1,3g9 admissions to the Dcparone.nt of Medicine for the Elderly. ln Ennis, 2.374 older peopl~ were admirced, 574 of whom wore admitted ro r:he Elderly <Are Unit. In Nenagb, mere were 1.974 admissions (over 65 years) and 181 nf these admissions were to the Elderly Care Unit. In rhe Region.J Otthopaedk HO$piral, Croom, 6 1!1 p<aple over 6~ y.;ars were admitted during 1997. The nUJnb<r of day cas<s ueared varied from 1,671 in the Regiooal Hospir.U <0 92 in the Regional Orthopaedic Hospital. with 506 in Ennis and 413 in Nenagh.

LONGS TAY CARE

re side ~tial serv i ces for o lder people

~~s-id.ential sen•iccs fin olde.r people provide a comprehen$ive c:ate mix. including shon s~y. rchabilitarion, respite, long stay and welfare c.1re.. There is an incrC":asing turnover through sho.rt ~tay and rC'..'ipirc: c:are which is supported by community b:t<ed day care.

strategic objectives

Residential Services for older people provide social :and hc-.1hh service); with the aprtS5 purpose of:·

• Offering fJcilicies ro resrorc independence to old('.r ptOJ>Ie to help thc:m mainujn independence at home

as F.!r as possibl<. Easing the burdeLl on art"rs/ rel:acivCJ by providing r~pitc and cehabiliuui\'e cue: for dc:pt'ndant oldc:r

p<ople. Providing sopport, inform~don and advice for thost caring for older people ;u home. l>toviding S(flsitive ilnd syn\p-.tthn:it continuing and ccnninal nursing arc.

2 4 6 8

10 12 14 16 18 2Q

22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72

l 3 5 7 9 ll 13 15 17 J9 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 S!i 57 59 61 63 65 67 69 71

MJ/1 Western Heatltl Board llesldemlaf facol<tJeS tor Olde~ People

DEVELOPMENTS 1997

limer ick catch ment area

A planning'"""' has been set up <0 prepare • brief for th< IUtur< development of sen·ices and acconunod.acion at St. Cami1Jus"1-Jospita1. The initial priorities~re the est:abiL~Iunenr of a permanent day hospital and extended rch~bili~tion facilities. including a d.edicated suoke unit.

- Subsuntia.l t.lectrical up·g.rading work was completed and a number of units were refurbished. Landscaping of the bospiml grounds commenced and will continue in 1998.

• A second phy.ician in elderly care medicine in the Limerick area was appoinred.

- An Age Assa:sment Unit is lxing provided at the: Regional Hospjcal, limerick.

Ln St. his Hospital the upgrnding of rwo units w~ complct~d :md a new lift lnsaUcd and c:oromissionc:d.

Oi.scussions commenc~ with local voluntary gtolJpS' to provide a dly ct:nm: for older people in Nc:wtastlc: West.

clare catchment area

In Sl. Joscph's Hospital, Enn.i.s, arrang.emenrs to rransfer 14 parie:nrs from Our Lady•.s Hospital to cbe new Elderly Memally lnllrm Unit (EMI Unit) wer< fonnaUy agreed. This transfer will be finalised in the early pan of 1998.

• Rcfurbishmenr of Unils 5 >nd 6 was completed.

· The <.1ttring ><rvicc for Our Lady's Ho.<pi~al and St. joscph's Hospiral was cencralised at St. joseph's Hosp1tnl and conunenettl OJ>eration in November, 1997.

In Ennistymon Ho~pttaJ. conscruction work on the link corridor. oratOf)'"and (:Onscrva[ories ..-.'aS

completed.

Pm of <he roof in Enni'lynum Hosp•ul """replaced and the IU<cb<o ..,.. ,... ... rd'wbished. 11 numbe:r of fire safety precautioru were unJm;akt"n induding thC' tnSt>11lat10n of flee doors.

hmiHymon Ho;piral woulso •warded the ISO 9002 <t•ndud.

• Tl.(' lmpro\'emc."nr wnrk ;u the· hQ..(pital was undcnakcn on~ partnership basis involving rhc Frir:nd} of Eltnisl)•mon Hospit.!, FAS and the Mid-w.,.,,.,., He:olth tlo.rd.

In Rahcrn Community llospit.l rooSIJUaioo work on the lbort-.tay n:babilitation unit •nd d>y hospiw ~completed. 11m p11>jt<t ,.., :dso a panncnhip invohing R•h«n Hospital Support Group, I A~ •nd the Mid-W<Stern Halrh ll<wJ

11tc main enuance dourw>y to Kilrush Community N..ning Unit w.as replaced and a number of improvemcnrs were carried out as p<trr of me rourine m:unrcnun~ progro~mme.

tipperary n.r. ca tchment area

· In the Hospirsl of the A.'->umption sanction to proceed to design \t.tt;e for a ~rlacrn1~1 hU>piW is .-.. iced. 8..-cwse of rhos. no major r<furbishmcnr wmL w<rt Cllti«< out during dtc year, .,;dt dtc <>ception of impRM11><nl'$ to the lcitrhcn and Rp>.ir< due to >tO<m damage.

- Work has commcnc«< on the P..Uouiw Can: Unit., Rn<u.a Commumcy Nuning UniL lr is expected thot this will be llp<:r.tUOnll by July 1998. Th., pmJ<Ct 1> >upponcd by Milford Ho.<pie< and the North 1ippcr.uy Hospice As.sodat•on,

A JocaJ Roscrca support ~;r~,up. 'Friends ofOea.n M11~well Ht>mc•, was esrnbli.shcd with ;'I vitw ro organi.siog f\md rai~ing t:\1\'"0I.i,

ACTIVITY: HOSPITALS FOR THE ELDERLY

st camillus', st ita's, st joseph's and hosp1tal of the assumption

_l.hcrc ""A'CI'C 1.740 adrniss&ons to rl1~ four hospitals fnr rht dc.krly du.ring 1997p an incrnsc u( 11 ":' on 1996. This i.s duto to an incrra.~ U'IC or r-espite ;~od short ~t3Y arc:.

Tlrt' raurnber of paticnh who~e lerlgth of scay on di~chargc w<.a~ le~ lhan six monrhs oontinut'd eo inc...re;as.t during 1997"' 1,591 wrnp:u'Cd Ill 1.424 in 1996. The"&< proftl< or p;uient< toidcnt in th~ hospit<lls Wa>

relatively unchanged •nd all of the brupitals hav< a greater fcm•l• than male popubcion

Then: w..u tow of7,.,46 At<<ndon= at d•y hospub dunng 1997. an,...,..,... ol 1.012 (I S.,.l on 1'1% 11>c most signiiJc.m increlSC ""'" dtc Hosptc:d of rhe 1\numption ~ .uccncbnca tooc by R~4 0?.5~).

ennistymon and raheen community hospitals, nenagh. roscrea and k1lrush community nursing units

Admusions w Community J lo~rntill .. and Communtry Ntu-..ng Unus U\tf(a.std by 50 from lC.l tn I ')Wl to 31l in 1997. Tbis is l;arp,rly ;aunbut.ablc eo m~ uK f!f )hoct ·)tay ~nd rapicc c.a~.

I 2 l • ~

6 7 8 9

10 11 12 ll 14 IS 16 17 18 9 20 .21 22 23 4 5

26 27 .!9

3C ~I 32 J3

" 3' 36 37 38 39

"' ·1 ~~

•• "- 4 .!6 4 48 49 50 51 52 ~3

"4 ,., 56 57 58 59 6Q 61 62 63 !;4 65 66 67 68 69 70 71 72

I'IURSING HOMES

Nursing Homes have a long rradition of offering ex{ended care to dcptndanr older people. ·n1cy cater for increasing numbers and arc an impomnt element in the overall provision of health care for older p<:oplc. Services offered include residential nursing and personal care for older people who cao no longer care for themselves. They ensure rha1 rhe medical needs of rcsidems are met.

The Heal1h (Nursing Homes) Act l990 and <he Nursing Home.• R.:gulations r~pr<Sents a strengthening of legislation on srandards and care for residc.ms of Nursing Homes.

The increasing demand for places in privare nursing homes and home suppon sc:rvicc.s present a continuing challenge.

During I 997 there were I ,368 approved nursing home beds in the Board's area. 788 people were in receipt of subvention ar year end and a further 72 people were in receipt of subvtntion outSide the Board's area. This represents an increase of almosr 7% on 1996.

mult i·age ncy approach

The improvement ofhealrh and well being of older people L• nor a single agency <ask. The inruvidual's lifes'Yie, environment and behaviour are influential. The Board has provided a range of home supporr services which enable, if possible, older people ro live in che oommuniry.

However, these r<Sources are Umired in a way io whicb residential services are nor. This leads ro a consranr increase i.n residential places whid1 mitigares againsr attomprs ro improve home supporr and non residenrial oprioos.

Mental Health

&ctrim Ntiu ANNUAL REPORT 1997

The Mental Health Services have undergone significant changes smce the publication of 'Planmng for the Future' !Dept. of Health I 984). Th1s document set out clearly the pnnc1ples for the delivery of Mental Health Care, 1.e ..

comprehensive commuOIIy based integrated with other services organised In sectors close to the people be~ng served

These changes have transformed the ranee. type and quality of service ava1lable to people and the M1d-Western Health Board has been to the fore 1n these developments

the serv 1ce aim s

· to promote mental health In the populatJon • to restore the mentally Ill to as Independent and normal a life as poss1ble

I 2 3 4 5 6 7 8 a •

I 11 12 13 14 15 6 17

18 19 20 21 22 23

25 27

28 29 J l

32 33 34 35

3~

3 40 41

3 44 45 46 47 48 49 !>() 51 ~2 53 'i4 55 56 57 58 59 60 61 62 63 6A 65 66 67 68 69 70 71 12

t h e se rvic e cov ers all as p ects of men t a l health and i ncl ud es:

Prevemadve C~re: The aim of pra'(.nt-.u:ivtr care is tU improve thC' mental hcah:h of the comrr.-uniry by promoting ~icive meoral health, liaising wjch referrlng agencies. giving lectures to ccunmunuy groups and prornotnlg th~ rehabilirn<lon or people wi<h enduring memal btaltb problems.

Anticipatory Cart: Resea.rclt on d\e incidence :uld prevalcm;c of mental health lssues: and rdoued problems.

Acute Care: Provided bOfh in the communiry rh rough don'l.iciliary visidng or ancnd:mcc at day hosplt3ls and where nc:ccssary in-p3ciCuc care in the Acute Unit au.achcd to the Rrgio~t.l Hosplta1l .. itrterick -and Our l.-1dy$ Hospirn.1, F .. nnk

Long Term Care and Support: Titis is pl'Ovidcd through a r.:t.tLge of resources and fudlicies and includes:

home suppolT drop-in cc:nne.to shon rerrn re.o:pir:e care <::ommul\ity r~ide.otial prog£arnmt:S vocational uaining programmes

- lung retm in·paricm arc

ISSUES AND DEVElOP MENTS

li m er ic k

All acute admissions are now processed through the acute psychiarric unit ar the Rcgiona.l Hospit3t Linleric.k.. The provision <.lf acut~ c:u-e for young adolescents in this unit concinues to be a major isstae :nld there is an urgcm requirement fin a dedicued acute faciliry for this group.

Community services are ba.-10ed in. five sector Day l lospirals. ThcJc: is a short~~ bowcvc:r, of high dependency r~idemial aoconunodacion and day care cemrcs.

\X'ork on the day c;;u:c c:crurc: at Kilm;a.llock c-ommenced during 1997 and is sdu:duled for c;omp1etioll in the lantr half of 1998.

Jlla.nning permission for the d~velopme:nt of a d:ly ceaue was received for th~ D04.m1dnyle :~ecwr.

lnpacirot rcsidtnrial services arc provided at St. JostphS Hospital. The objective is to pro~id.e ahemativc accommoda~ion for the ddcrly and mentally handicapped paticms who arc inappcop•·ia<ety placed at Se Joseph"s Hospi<JI. The de\'dllpmcnr .,r residenti>l•ccommodation m Lisnagry (Dauglner.s ofCiuriry). which i.s now at d~ign :;taw!~ ~~u :l('COmmod;ne 36 p.uients on rran.sfcr !Tom St. joseph:o; Hospiml.

c l a re

A~uu~ inpatient .services are provided in t11e Admission Unit at Our l.ady1S Hospital. The plaAning brief for lht: ne\ .. 3l.'Ute uoit on the groun<h of f.nnis General 1-fospir.al is with che Depart:mcm of Health awaiting approval m proceed w design st<~gc.

Thcrt ls an urgent rcquin:oH:nt for addirionaJ bigh d<..'Pc::ndencr n:sidential accommodtltion in Ennis and £nn~Stymon. Signific.~-nt <:oapit31 itwtsrmcn( L..- rt'qu.irtd ~o provide ;i)rcroativt- accomm<K.btion for paricnls in Our LJ,ly\ Hospiu.l, E.nnL'>.

A further phase of rhe centralisation of store.-: took plaee wirh the u01.n.sftr of the purcha-:ing funaion to Ctotral Stores, Lime-rick

- Work commenced on rhc high deJ><:ndcncy residence ar Kllrush in Augusr 1997 and is <chcdulc:d for cQmpletion in 1998.

• Work on residential accom1'nodadon in Ennjs for people with ]e;ltlling disabilicles is now eo m piece.

- A p~an for a low dependency re:<idcne< and day u:nrre., Sbannoo duougl. rhe •cgis of'Resf"'nd' awa.Jt«! pl:tnning permission ar year end 1997.

A property for • day centre or Scariff ".._. pu.rchascd.

An agrecmen.t with .staff represern:arivcs w lrau.sfer a number of elderly pa•.i.cnts to more ;.1.pproptiate :a.ccommodauon ::n St. josepb's Hospit:d~ Ennis, is Jtar fin~ lity. The! provision of res.iden~l ac:commodacion fQr the remaining patients with le;tming dt'i;~bilities is being arranged through 'Rt>$pc:md'.

- The cenrc•li,...rion of catering ~ervice. ar St. joseph~ HO<j>il31 n:s1tlred in the dosure of rbe kitchen in Our Lady's Hospiro.l in No\'cn>ber 1997.

tipperary n.r.

The lack of dedicated inp:uic:.m acme &ciHtics for this card1menc area means char patients hnc e-o aavc.l outside the region for such $C:1Vic:es. The.rc: is an urgcot ncOO ro proceal with c-he design sra~ of th:c Acure Psychiouri~: Unir ar Nenagh Ger:l~ral Hospital. Oepan:mc:nt of Health approV:d it :awaited.

Day Hospiral servicq are now wcU cs~abli.shed at Ncoagb and 1lt11rl.:;.

The priority iss:ut.'S arto th~ pwvision of high dependency rC$Kiemial aGCOmmodado-J\ in both $CCOf areas and a day cemrt! ~t Nenagh.

OLD AGE PSYC HIATRY

'l11e old ag.: p.sychi<nry service is based in limrrick and commenced ln 199S undc:r the direction of :a

temporary consulOillt in Old Agc l'sycltiatry. A permanent apf"'inree was tt<Ommended by the Local Appoinunents Commission t.OW'ards me end of 1997. The service comprises of inpatient """' (long-stay and ~'pie-c) shorr sray acuce (dementia and funcriono1l menr:~l illness) and community ouueach services.

VOCATI ONAL TRAINING

Voco!ional training is pwvidcd ot Limerick (Rahccn) and N.,.r;astl< Wesr ond ar Enni> (Dulick ~no re) and Kilrush. There ore 93 ploce:< available in Limerid< ond Clare providing L.vel I, Level Z and sluJI based training. ('.(uu.tn.crion of rhe new workshop at Dooradoyle in Umcrick commenct'd in th~ b,u=r ~n of 1997. The community worksho-p fudlirito.$ ac Kilrusb will cr.msfcr to tbe Ordwd Horel campus on completion of reooosuuction oo tbt" latter site..

ACTIVITY

The admission "'t< to acurc care per thotuand fur the Bo.n:l far 19')7 W.U 5.>4. ThL< oompar.-. wdl with the nat:ionaJ rare of 7.96 pc:r thou~nd for 1996. Thr day hospicaJ. d:ay ctnue and out~p.uiC':nt :utcnder rares were 8.0, 1.2 and 9.8 per thousand respectively. Compa.rativc n~tional daGi for communiry activity i$ not :o_v:oilable.

1 2 3 4 5 6 7 8 9

10 11 12 13 14 !5 16 11 l8 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 >4 35 36 37 38 39 40 4] 42 43 44 45 46 47 48 ~9

50 51 52 53 54 ~5

56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72

diagnosis

The ovc.f;lll domin,am admission diagnosiot was:

Depressive Disorder Schizophrenia Alcohol Disorder Mania ~§~§~~ 26.1% 21%

20.3% 11.68%

NON MEDICAL SERVICES IN MULTI·DISCIPLINARY TEAMS

psycho logy

Clinical Psychologists pt~nicip:uc; a.'i members of muhi..disciplinary teams and S«toi'S. Their acrivirics include clinical assessm~nt :and u-e:umem intervendoos and research.

socia l work

The: social work serv-ice assists individuals eo achieve sclf realisation and poremial. lt ~lso create.'\ ~ware11ess of dghts and entitlementS and how £0 access d1esc services.

occupational therapy

OccuparionaJ therapy is dcsigo«< ro provide asscssmcm <\ad treatment in the u._~ of $C::Iectcd and appropriate ~crivity. The purpose i.s to PI"C'\'Cnt di.$ability and tO fulfil the individual's needs by ~chieving optimum function ;a.nd indc~dcm;.c:.

addiction

The servjce expanded io ili<' Clare area in 1997 with lhe appoil\tmenr of2 addiction counsellc>fl. Services are provided in acme u.Wu .and day hospimls. RcsidenciaJ treatment is available in the I..imc:rkk and Clare carchmcnt a..-eas.

voluntary organisations

Thtre are a number of voluntary organisation." lnvolved in the mental health services including rhe MentaJ H :>hh Associacion of Ireland. CROW. the Schizophr<nia A>soci>tion and AWARE.

Tht: Ct)nuibution of voluntiry organisarions is esscmiaJ in gaining communicy support and in changing attitudes to mt:m:al illne:u rhmugh education and health promotion.

Mid We\lern Healt a aut

research

The Board is paniciparing in 3 research proj~r on the incidence and prcvaJcnce of parasuicide wlth the National Sui<idc R<iearcb Poundatioo, Cork.

\Vork on the r.:osr effcc:dveness of ah·t:rnarivc acute caJ'e- in the Limerick south cicy ~uor is- completed and a report will be i.,;ucd during the early part of 1998.

A research project cm schizophrenia is ongoing in lhe Clare area.

A r~arc.:h project on tummt1nhy psychology and clte imp:ttt of rhc clinical psychology set\' ice is ongoing in rhe Tipperary N.R. :ue>.

A soudy on the prevalence of mental illn= ln older odulrs in Limerick is scheduled for complerion io the early pan of 1998.

qua li ty initiatives

Audjciog of medical record kc:eping and monicoring pressure sotc nun.a:ge:ment which commr:nced under the Biomed Pro jeer (the sccund E.U. concened acrioo prngro.mmc for q.Wicy asslll:lnce in hospirah) continued in Clare.

The vocarionaJ rcajning centre in Ennis and Umerick weTt 1udittd for Ll1e ISO 9001. Ennis has bttn awarded dte ISO 900 I qual icy aw.~rd and Umerick, who ha•'< b<en ~ and registered as m«ting the requirements. wiU receive the aYo';lrd in 1998.

A quality of life survey of people with ~oduring mc:ut;d illnC$$ll\•ing in community residmces has been completed. R<:sult$ wnl ""available in 1998.

M•d Western Heo/tll Board

Acute Fac;fitiiJs for Memat Hea/tll

• 2 l J r; 6 7 8 9

10 11 12 13 ~ 15

16 11 18 19 2(1 £1 2Z 23 '4 25 '6 27 '8 29 >0 31 12 33 34 35 36 37 38 39

1 •• .. ' 44 45

7 .a J

50 5: 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 10 11 72

fJ We r

2 4

35 3

4 43

I 45 Learning Disab11it1es 46 47

S«tum Tm ANNUAl R£P0Rl 1997

Development of servrces for people with learmna drsabrhties arms at proVIding a comprehensive range of services throughout a person's hie cycle. These include assessment, education. vocational training, day, re sidential and lherapy services. In recent years the rncreasrng age of people with learning disabrlitles has presented the Board with challenges to meet therr changing needs. 1t is recognised that rn order to respond to unmet and future need detarled forward plannrng is necessary.

The Natronal Intellectual Disability Database was established durrng 1995 to ensure that rnformatron os available to enable the Department of Health, the health boards and voluntary aeencoes to provode appropriate servoces for people woth an ontellectual dosaboloty, and

assocoated problems of their lamohes.

18 49 ~I

~· ~4 ~

~6 57 58 59 60 61 62 63 64 5 66 67 68 69 7 I 2

The firs< annual reporT of the National lntellectulll Disability Database W'.IS published in 1997 >nd the foUowing ilJlL'\tnces che Mid-West po~lNont

number of people with learn i ng disabil ities

Mild MO<lerate Severe Profound Not Vccifoed Total

1.199 903 352 104

10 2.568

numbe r of people ava i ling of se rv ices

Day Services Residemial S.rviccs No Scrvie< To<al

STRATEGIC OBJECTIVES

1,627 7 17 224

2.568

w supporc and promote fhc development of people 'With learn.ing disabllities to cbe maximum of 1 h~ir porcorial. tO supporr people with )e:trnjng djsabiJit..ies and Lbcir fumili~ and carcrs CO lh~c as 1ndcpcodcnr l1 liltSt)'le as possible in their uwn hornes and communities.

- to provide high qu.alily day c.a.re, rcsidenrial care and family support seryic:es in local c;ommunicy- :ue:.ts~

KEY DEVELOPMENTS

Services for people wirll learning dis~biHries are: provided by rhe Daugh1trs of Ch-arity. t;sn;.gry in Limerick City and Wt Co. Llnlerick, d\e Brochers of Chariry, Ba"ltlmore in L.im~rick :a..nd \Vt"Sr Co. Limerick and Charleville and Di.suict Associjtion .U\ South Co. Lin\e-rick. Services are provided by th~ Brothers of Charity in Clare and by Sr. Anne's, Ro<crea in lipperuy N.R.

che lcvd of d•y •nd raidenri:tl places io dlc region was increased in 1997 as follows:-0dy Servi~-e.s - 45 Reside,uia1 Services - indudi11g res-piu: - 21

the direct funding agreement of volunrary ageJ\cies W3$ a,gn::t!d and p\1blished in ' Etlhancing d\e Partnership'. These arrangements will come into efTect from 1st J;mu:try, 1998.

residenti:al unif$ ''>ere OJ>t:ned in Ballyhtnders and Kilmallock in 0)-(.)perat:ion witb the Chadeville and Disuict A~c:iatioo.

rbc couusdli1lg nurse service provided ongoing supporr to families of' children and adults with special needs. There '"""' 78 new r<ferrals to this service in I 997.

- :,a property hotS been pl.m::h:ucx) in Rorrisokane. Co. lipperary to develop a comntunity residence.

- a dinieal audjl or the Jmcllec:tuaJ Disahiliry Darnbase was C."lrried OUI in November l997.

a Rcgioual Auci.sm Assc .. smcm Suvicc Wa$ esublishcd.

eh< d ..... clopmcnt of accommodation for 36 people ar rhc Daughre"' of Charity, Lisn.'S'Y has =ched planning ""11" ond will be complcccd in I 999.

- a residence for r<n people w3> escabllshed or Kilrush. Co. Cl:orc

M fie .,, ~.,,, 0 V

Physical/Sensory Disabilities

I Sutrim Rltl'l!n ANNUAL REPORT 1997

The focus of the development of the Board's services for people wtth phys1caf and sensory d1sabtlttles Is to enable people to live as tndependently as possible w1thln the1r fam1ly circle and In their local communities.

The ma1or driver for change in this area was the report of the Comm1ssion on the Status of People w1th Disabilities, 'A Strategy for Equality'

The Board works 1n partnership w1th people w1th diSiblilhes, the11 carers and fam1hes and the voluntary organ1sattons wh1ch prov1de serv1ces lo and act as advocates and representatives of people w1th disab1ht1es to ensure the development of a quahly and equ1ty drtven serv1ce

~ Reg1onal Co-Ordtnator of Services for Dtsab1hhes was appornted w•th respons1b1hty for serv1c e co·ordtnat1on for persons with phySICal. sensory and learmng dtsab11tt1es.

The lack of rehable Information on the numbers of people needtng a semce and theu prec1se serv1ce needs IS a mator defic1ency tn develop1ng serv1ces. The development of a database of persons w1th phystcal/sensory disabilities Is a PrtOtlly.

I 2 3 4 ~

6 1 8 9

I 11 I I 14 15 16 17 18 19 20 21 l2 23 2~ 25 26 27 28 29 ro 31 2 33

34 35 36 3 38 39 4C 4. 4.! 43

4 48 49

Sl 53 54 fi5 56 57 58 59 f>O 61 62 63 64 65 66 67 68 69 70 71 72

STRATEGIC OBJECTIVES

- to develop and ddivor service.< to p<:<>pl• with physical/ sensory disabilities guided hr the principles of equallty, m:t..Ximising participation :tnd enabling i1tdc.>pendenee and choice.

- ro imc:gnne~ where possib11!, all services for pt'op1e wirh physical/ sensory disabilitics ioto mainsrream services. e-o develop S<'rvice$ at loc3tions :md wid1 fadliries wbich allow people with ph}'·sical/ sensory disabilicics tO accc:ss lcx:olly based servi<:eS. to promote the. dignity, right.\ and independt:IICc of all people \\'ith dis:abiliries. "'•nhanc:c tl1< quality of tife for peo.ple and families of people witl> dl<abilicies.

KEY DEVELOPMENTS

the occupational therapy servi-ce provided se.J'vice:s to l , 179 people in their homes, scb<)()1~ or place.<~ of work i.n I 997. The aim of r.his service is eo maximise peopleS indepe-nde:net! ~vi rh in rhe COilfinelt of tlaeir disability. l.584 b.omc visits were undenakeo.

rhc community pbysior.bera.py SC'rvice is bein.g devdQped in e-ach area r.o en.~re that people't nct:ds are met in lhtir hornts. 601 people received a service in 1997.

- addicif)Jml gr.mc aid w;u made available m volumary bodies providing services.

pi:"" to provide a Yc>ung ChroiJic Sic~ Unit ar me Regional Onhopaedic Hospital, Croom were funher developed. Thcte >re 34 I )'o\lng cbr(>nic ~i.ck people in <he region.

· a co-ordinating comJniuee for ph)'$ic:tl 3nd sensory disabilitit$ has been escablis.hed tO advise the Chief Executive Officer oo prioriri~.

• spc:cial allocation <o provide aids and appliance< w:>.< .-..:eived in Ocwber 1997.

a posr of Speech and language Therapist was created in lipperory N.R. community core area. 2,636 p<ople re«:ivecl>peech therapy in 1997.

M~:J·WE>"5tep1 lita 1t1 Board

Acute Services

Suti'on Twe/,•r ANNUAL RL~ORT 1991

The Board's acute hospotal servoces are provoded on the Regoonal General Hospotal, lomerock, Regoonal Maternoty Hospolal Lomerock, Regoonal Orlhopaedoc Hospotal, Croom and Ennos and Nenagh General Hospotals. Ourong 1997 a very substantoal oncruse on hospotal actovoty was on evodence. The range of specoaloues avaolable on the Mod-West oncreased, the bulld10g of Phase I of the Regoonal Hospotal was completed and Phase 11 commenced

strategic obtectoves

The strategoc ob,ectoves for acute hospital servoces on the regoon are:· To partocipate fully In an ontegrated system of health care whoch has the aom of ensurona that each person, and the communoty as a whole, achoeves and maontaons the optomum level of health and well beong. To provide approproate, tomely and eflectove servoces for the doagnosos and treatment of

acute ollness and InJury. To use the resources avaolable on a way whoch achoeves equoty, quality, accounlabohty and value for money.

· To measure results as an ondocator ol progress In achoevong our goals.

2 J 4 ~

6 7 8 9

I 11 12 I 14 I~ 16 17 18 19 20 I

3 24 25

27 18 l9

!I 3J

34 5 36 37 J8 .!9 4:) 41 42 43 44 45

• • IQ

50 SI ~. 5l 51 ~~

56 SI 58 sq 60 61 62 63 64 65 66 u7 68 ti9 70 71 72

To aohic:vc thcose obj..,tives. me Board adopted a snotegy for ocut<: hospital services in 1988, aod aoocptod rtcommcndations ofComhairle na n-Ospidc:al (1991) fOr the development of speci.Jist services in me Mid­W<St. The Board also prepared •nd adopted a numher of reports relating to development or specific sema:s, e.g. Maternal & llarly Child Hc:alth (1994), E.N.T. Semccs ( 1994). Oncology (1995), Orthopaedic Semcc:s (1996) and Pathology Services (1996).

Sub<t:antial progress has heen achieved in broadening the range of specialist services within the region and in in\proviog hospit:.l f.tdlitie.~.

TREATMENT ACTIVITY - ACUTE HOSP1TALS_l_997

In Paric:nt$ Out Pttrienrs

A&l! Anendanccs Day Cases

Review New

T11rg't Acmttl 35,717 38.268 68.306 71,942 24,163 23.395

86,243 87.014 10.467 11,787

REGIONAL, REG_IONAL MATERNITY AND REG IONAL ORTHOPAEDIC HOSPITALS_L IMERICK

key deve lopments

Tiu~ main fearurcs for \997 WCrt a (iQ.nlUtiC incrt:'ase in activity. subsramial progress in caphal devdopmcnl and tbc con[inuing improvement in the rar"\ge of :;pecialis( services available.

Major capiral de,.dopment~ eonrinued •< the Limerick Regioaalllospit.J sire in Oooradoyle. On lOth March 1997 the rhcn Minisrer for Health, Mr. Michael Noonan, T.O., officially opened rhe new C.T. Scan and Nuddr Medidne Depanmenrs. He also opened the most modern Cardiac lmaging Sui[e in Wes[ern Eumpe. The cosr of building the unir was .E0.5m; this funding was •llocatod by the Department of Health. Equipping me unir cosr almost£ I m and 1hu funding w•s provided by tbe Mid-\'<lesr Ocvtlopmc•ll Trust.

Phase I Devdopmc:nt 3t the Rc:gional Hospirnl $ite w.u t:omplcred :and handc:d over m the Board in November 1997. The 1\tw Our·Parients Departmt:cH was occupied (Ow:mb the end of November. Major equipment purdl:ases rel3te to Operating The3ues, Rec:o\·ety Room. lmen.11ive Catc Uni[ and new Rcn'31 Dialysis Unit,

Tht present Mininer for Health, Mr. Brian Coweo. T.D., laid rhe foundation stone for Phase 11 Dcvdopmcnt :and work commented in August 1~)7. This development is much more compiCl'C rhan Phase I in 1ha1 it is a combinacion of ntow building ;md r~devdopment within the exisring ho.:•pitnl. By the end of 1997. Lhe old P-Aediatric Unir wa< demolished •nd n:-locaoed remporarily within rhe exisring ho~pic•l. A portJon t-.f rhe C'Xhting Laboratory W.l.<i llso demolished and sutf re-located to temporary premise$. Amngemt'nts were put in tr-~in to reiOQte a large numbt:r of other depanmems /units on ::l tcmpora.ry or permanenr ba.<is o> pm ofl'h•se 11 Developments. The"' indurled me Medical Records Depanmcn1, the l,harm:u.-y. the Acx:idcm & Eme(gtm:y Otpartmt:nt along \\~rh the m:tin hospiral entrnnce ;t.nd 'oncourse.

In addition to the m:ain contmctS. ~ubsmnrial .addiriooal woric w:a$ canied out during rhe yea!', both by <:ontrotct .1nd tlirettly by che lioa:rd$ <lwn St.aff under the direction oF the Technical ~rvict'S Officer. These included:-

<Omple•ion of the Conliology Unu upgrodong of the l're-N;t~•l W•nl a1 rhe R<-gional Maoernity Hospital complerion of w.ttd upgrading .n St. P;urick's W31'd llnd che commencement of Sr. josc.ph•s Ward at thr Rcgion>l Orthopaedic Hospital

• oonrinu•unn of the ward upgrading programme 1t the Rtgionol Hoopiral Limerick

M

fn p.ualltd with th(' consuuaioo work. chr nngt' of '~"""'.tfl,t ~men auil.-abiC' eo parkou conunua.l 1o t:\pJnd, the n1o~c significant bemg::·

t''\:P<liHit)rl of the Cardiology Service <iM'nntclit.:t;HlCnt of a Hael'n.uorogy Service CXfMIUtlnr' of Oncology Service: undct the ampi(;(~ of the NouionaJ Cant.:er ScratCg)' int 1odue1 ion of Oral Surgef'y r.pacl>lon of Ophth.Umology c>p.1111ion of Ud<rly Care Se..vice

cardoology The Scl'\-..x \t.utcd in 1996 ond <b-dopc.J lianhcr don"' 199- '"th IlK provision ul four d.v bc.h dunng chc <our"' of the yeu. 1.259 aso _,.,dale""" dunn~ 19'r •nd the scmcc pro>idcd iodudcd A"&'"'"""'· lcmpor:uy l'>cenukD. Right H .. n Pm>ur<1 ond l'<n::•nl..J C.p.

h a e m a t 0 I o g y (including blooclm.._.fu,on) A con"clc.cnc hacm>tologisc cook up duty .. ich tht &.\rd cn September 1997. The pose is • kty clcnccnt in the dtvelopmcnt of oncolpgy services in accordan« wnh chc Bo.ords 1995 ~tr.otcgy and the Narion•l Canc;.cr Srn~rcgy. Since takiJtS up ducy. the comulmnc hilc:m.uoiO~li' ha,, laken over rc:spc;m\ibiliry for rhc fl lood 'I rnn.o;fusion Service in chc Region and h-:a.s \cc 1 he t:trgt't ro est:tbli..sh an evidencr based tnn_\ftl\tOn $-l'rvice .u l.inu:rick RcgioaaJ 1-lospiral. including c:!lt:thlhhmcl\1 of .m cffecci\'e uansfus-jon commitrtt'.

onco logy services A dcr«cor of <AA<er scr.ucgy services fur rhe Mcd-W"'c R<-gion ha> been •ppointcd and during 1997 auhfi,hcd a Kn>up ro plan the <b·d<>pment a( ''""'ces •• I<C()N>n~ with the Notional Smtcgy. Among the key """rnmcnd.rions m>de we« che appoincmcnc af a mcdul oncologisr and • p>IIW.,·e ~ c::on<ulunc. wlucb ..-c rug= for 1998. The brm •f'PO'ncmcnc will be a joint"!'P"intm<llr woch Mrlford Ho<pc~.

orthopaedic services Approval ,...., ~"-cd during 1997 for an .oddition.J po« o( Orthopxdic Surgron. The po>e ,..,.. ad~ by chc l..oc:•l Appoincmcnts C.ommission and chc •u.:ce<<ful•pplccanc Ill .d!cdulcd to ala up dui)' en M1y 19')8.

"" " 52

.A> 'i8 t,Q

~

25 1

29

4 4 4 4

53

t J

59 61 63 6 6 69

1

o r al surge ry A con•ulam oral surgeon wok u1> ducy in AuguS< and has <ommcnccd providing in-pau<nc. d•y t.l"' Jnd Ollt·pacitnt servica in Limerick Jnd h.L\ :al~o begun provi~ion of ~rvict'!. in [nnis and Ncnoagh. f"hi\ provide>: a locally based service for p.uiencs who previou~Jy had eo u:wd to Dublin or Cork fi)r C>r.ll M

nMxillor-'cittl surgery.

e lder l y c ar e servi ces A SCt.Ond c:om·u){:lnt in gcrienric m(dicine :.u th~ Regional H(»pir2l took up duty lo Febtuuy J 997 Funding for 1997 prcwi<kd for the n«:<s<ary m«<ial support Slofl' ••d the commeru:~mem of> cLy ;asscs.;m<nl unit for olckr pcopi<. Thr aim is to r<ducr rh< number of odn1i«ions of olckr people.

o ph th almolo gy A rrplaamonr roruulwu u••k up dui)' in Augus< 1997. l'mpo"''' for • subsi2Jltial incrn'• in cl.cy work were actively under consid~:r-.u imt :n rhc yearS end. 1l1oe indud'" a proposal eo carry out mor~ t3t:~~racl upcraOons on a day basis.

SERVICE PERFORMANCE

rft~rt Ius been :m oalmost c:oncinuOu,\ tncre:LS< in [be Dl1Dlbet of in·ponicnts and da)' ~ tfnttd 1n tM R.gionol Hospi..J Lcmcrick in the b>1 ten )"ellS.

30.000

25.000

20.0011

15,000

10.000

~.000

0 1997 19')6 199S 1994 1993 1992 19?1 1990 1989 19KK

• Day Cases 0 ln·PJ1irnrs

l'h<rt: ,..., • <ubS<onciol <n•ctt<c in 0\'tNil)' for both in-poctknt> and d•y cases compor<d v.ich the np«t<-d .hlivil) 1n cbc 199- Scmtt l'bn .. indiat«< in the foUowing t>blr. "'hich adU<!cs activity undcnak<n undt'r 1ht' \l~ring Ust 1nm;au\'c,

I lo.<piral

Rrgion•l Hospital

In P•ucnts 19?7 'l .. rg<e Actual

27.002 29.317

D•r c.,...,, 1997 Tors« AcHml

6,610 8.233

M d·We ste~ H I f

The inc,;ru"" tn aai .. ·ity is~ as a combi.natton an~•ng from u~re:1\4!d ckmmd md the add.UtorQI 'f'«UI~a ten·~ ~vaillbk. In particubr. dlc:re Wt'f~ ~tbun1UI in<~ 1n in-putan activity ri>b«lng 10 u.~ of Older f'<,1pk Csn,holog)·. Ortbopa<dia. Ophthalmnl<>gj·. L'I.T., G).,_.,togy/Obsrcmo ancl SC'On•roln~y. D•y as< .arrity for Gcncr.tl ~ftdiOn<, <ou'l:<'Y• Onhopo<dics •nd Oplubalmolog) >Ul»12nli•Jiy CX<ff<lrd r.trgru.

Oul·(':&tient :tt."'tiviry \\'015 broadly .in accordanct wnh (1(pc:'n:uinn~ forth~ )'eat while Acciden1 &t Emetgt"nry aucnJJnces oonrinucd m~ increase wbkb lw been .:xptrit'nred 10 rCCX'nr rears in respect of n~· .mcnd.1ncrs. with rc.·\'icw arrenda.nces continuing to dedinc in 1997. 1'hcrt-wc.rc 50.570 new and 6.~47 review ('.;A$('., \f~n in chc A&l:. Ocpanmen.t.

The profile of 11crivity by diagnostic relared groupiull' co111inu«<Lhrough the Hospitalln·P.uenl Enquiry (I I.I.P.E.) •Y'Iem wilh 1hc rop thirty DiagnoSiic Rd•«'ti Croup• (D.R.G.s} accounting for appro>Jnmdy 40'lo of •11 admis.<ions and abour J/3 of all the b«l day• u.«<

WAITING liS I INITIATIVE

In 19')7. 1hc ll<>nd reJ.'ft>cd ao alloarioo of £424,727 an r<>p«t of !he Waiting Lis< lnim•i~ J\n addmon.J 800 proccd""'" "_,carried our rn (.;cn<r.d Sufl:<ry. E.N .T., Gynaecology. Ophthalmology. Onhot•acdiu and Dental.

ENNIS GEN(RAL ~OSPITAl

The fo llowing graph illustrat~ Lrends in in·parients aod <l:w c;JM$ creaccd in Ennis Gencr~l t-los.pit.~J Jn the

'""' len yc;~rs.

6.000

s.ooo

4.000

3.000

1.000

1.000

0 1997 1996 1995 1994 19')3 1992 1991 1990 1989 1988

• Oay D.scs 0 ln· P.uienrs

--·-' fior f.nn11 (;.n.nl H"'Piulan rho a>o>ro.r of the ~ A Oocloprn<nr Conrrol Pbn has been l'"l'""u '- L. of •• ...c1uua anJ ,,_ _ _ 1cam .._ · ~>..,-.:hW • Uni1. "->1, ..,.. '"" •PI""•nnm• -· '":"""' """d opmcnr ol rhe hu•• • •r rx · • .... ~- he mJ oii?'J7 ~ h>r! been m.cn-cd wcr< \Ubmincd 10 rhe Ocparon<nr of H•alth. ban I'll ' ""

I 2 ~ 4 6 1 8 0 • l ;; 4 lj

'6 17 '8 )~

• • l <3

24 25 26 21 28 29 lO 3 !2 n l4 '35 l6 l7 38 3'l 4 4! 42 43 « 4')

40 47 48 49

A •

54 55 f

GO 61 62 63 64 65 66 61 68 6'l 10 11 12

During 19<)7 a~uci;a.l mcdi~.._l «!Uiprnc:m ....,:a~ 1"'"''-h.O..<~ed, ir~cluding:·

.. pomable '\rentilator porablc E.C.G. m><hinc viu.l signs monitOr and pruner blood gas arulyscr Cll'1:lCn control unit and adipter for mcdiul and sur&iaJ .. ards.

Approv:ol was m:aved from Comhairle n.• n.OSpidd for a repl•e<lll<!nt Consolr.anr Pbysici>n -..-bo will J,;,.., on alt'o1<0hmcnc to I im<rick Rcgio<Ul llospu.al in rospecr <>f Cardiology.

llospiul

Fnnis Gcoc.-.lllospital

In l'aiiCill> 19')7 Tugcc Aau•l

1.561

Day Cases I 997 Target Actual

2.068 1,813

Out-p.uie.nt ac..--c•vny (4,090 new :ntcndano..--s .;u\d 8.967 n::rurn visiu) was ln line with largets and Accident & Emcrgt'ncy auivicy ,howcod a slighr inen>:ue in now >llond•nces 14,809 (larger 14,658} and a reduction in relum VlS1lS.

NENAGH GENERAL HOSPIT~L

The: following graph illu.~u.uc~ U't'nd,, in in-p:uienls and day C1.'>eS arcarcd ill Ncoagh General HC!$pit-.:d irl the la.'lt ten yC'ars.

6,000

5.000

4.000

3,000

2,000

1.000

0 1 997 I 996 I 995 199•1 19'1 J I ')92 I 991 I ')90 1989 1988

• DayC..SCS O ln-P.ricnr>

A Dc.dopmcnr Concroll'lan for rhe sire lu.< been prep><ed and :uch1t«:a ha'" t-n oppoimed ti>r the dt:Sign o( the- Armc l~ydu~crit Unu. lloYot"Ver, apprt)\'31 h;u nor yet been rcc~i\-ed for the remaind~ of the dtsig.n tcJm wh~eh l~ nk:ntio~l 111 order ro pn>t,fl'e"l; rhC' proj«t.

Durint;t tht" ye.u, fi"'C'nt~J m«ht..Al cqu1pmenl. includ,ns an •n~rhcric m.achinc, defibrillalor and umlngy cquipmem, W.t..\ J'urch.,~.

The m:w Uf'gtJded ;md rc-furbl'haJ Oul•l'.uicms OcJl.Utmcllt W'J.-~ opened hy tbc Minis[Cf for Health.

Ho.<piral In P•ti<m> 1997 1\ugtt Actml

D:ty C."c< 1997 Tars<t Awul

I .78') 1.741

Oul~p.tcM:nr Jetiv1ty t\,.'!62 n~· ~ncnd.Jncn ~d 7.347 mum vi.l.ul Y.'Ctc bnudly in line warh Utp'G -.-·h.ik nrw mcndanccs Jt A.."tlcm &: F.mc~n<)' (, .860) shoo'<d • wb.un11JI '"'"""'aver 1hc "''t:<t of 7.1 00. Rccum atrmchnct!l. "ho"'cd .a dctrt;l$<'~

OVERAll REV IEW OF ACTIVI rV

reg ional hosp•ta l complex, ennis and nenagh general hospitals

ln-p.ttient utivity for 1997 "-.. jtJ.>I O''t'l' 38.000 comp>r<d wnh a tug« of35.700, -wbik d•y a« acrivuy o.aN<d 11.500 rootpvnl ,.;rh a '"'t:<t of 10.500 and ne,. ancndJoco .n Accidenr &; Cm<!g<n<)'

[)q>.tnmcna roalkd .!moo 87.000 cornpvnlwilh an .sumao<d 86.000. Of lhc io-pmrnr adml'•toru, lW~ "'"raU WCtt adnun<d 2$ cmc~/wgenr """'- In lhc RtsiOn.J l!c><pn.J Compkx rhc r~·· ""' 8.!". and fOr Eonis and 1-im:agb Gcncn.l Hoopit:lb 92% '" o.h 1'3v<.

OR I H 0 0 0 N T1 C SERVICES

1-ht Orrhodonric Sc:rvict w.t!l extended tu Kilntsh, Shannon ~nd lhc !ICrvice- w;.s maincatned in Brurr o~nd Roxrowo. 1~ht sessiom were incrcasc:c.l m Thutles ro three p<r week. Tht new Ordtodomtc Unh in Ncna&h ha. iu.sr !><en opcrt<d. Durtng 1hc building of this Unir rr ""' nc:<XS»ty ro close eh< existing f><-tlrry and p.tli<nl'S &om that area had 10 m•·d ro Limerick

The service of a res<omrvc demist commenced ooc day per week, Tbu has .,-odt<d om \U)' •dl and rr has ITIQm <hat compltaonl c:a.<e> such ., cld't palat<S, Ctn now h,,. iOpbisuco!Cd bridges and omp4no fin..! rollowing mci< onhodonu< ucarmcn<, iOmcthlng th31 could no< be done pt<Yiously. The ncnl ro. poumu woth complia.rions 10 u;wd on a rqjulat basis for surgery ro Dubltn and Cork h .. been !Cducc-d

treatment activity

~'oUting for rruuncm Active CI'QUDCDl

W.iting fOr asscssmcm As.o.<d

1996 215

1,959 2,575 1.117

1997 3~2

2.343 3.318 1.2n

An incteasc in rhC' numbtn Wiltting uc:currtd despt~ tbc ~.J rh~c cht numbu commmccd ~nd under ~1\t <rcaunc:'" in 1997 was gn:;ncr rhan on 1996. Rcfcmls ro this scrvt<'C h.Jvc im:rnscd li-om 1.5~ on I W~ ro 1,970in 1997.

AMBULANCE SERVICES

A toral of nine ambulancc srauons ,,.. maintain..! in rbc r<gion • f'our tn O.re. twO in Ltmcn..k •nd three on lippcruy KR. A ccmn.l control symm opcr.ncs in Ltmcridt fO< the ennrt ~· """'" H <mcrgwcy ambulances arc matnrainnl and rbc toW J of ohc ' '"'"",. appcownardy 80. All "'~""'" "" borh rhc Ambulance and Trorupon Sw'"" m: cle:alc .,..;1), cluough rbc Boatd's Ambulance C.W.rrol Ccnuc

at Dooradoyle, Lim<rick.

4

8 I? I, I I ' 11 15 16 I/ 18 lfJ a> I 22 lJ

4 2~

2 Z8 l9 3(i 31 ~2 ;J 34 35 36 37 J8 J9 40 41 42 43 44 4 46 47 48 49 50 51

56 57 ~~~ >9 ;c I &2 63 54 65 66 67 68 69 70 71 72

0 Ar!lbulance Base 0 GMI!fal Hosprtal

strategic objec t ives

- Care and tra.llSpon of serio~LSly ill and injured persons to hospir.al i.n emergency situations . ... Planned journeys where the medical needs of me pacient indic.1te :1 rt!<.lUitt'.ntent for an ambulance.

111tJ(' C411 b~ summariJ~d tJJ:­

Presc:rvation of Life P~enting p:niems' condition from dcteriora1ing Promotion of recovery

ln addition. the mmspon service deals with cranspon rcquirtments of a non urgent cype. e.g. patienrs attending for renal dialysis. at Spt'Cialist clinics in Dublin, ere.

issues, developments an d servi c e performance

The key objoctiva for the S<rvice ar<:-T,.ining .JI st>IT to emergency medic.J technician (E.M.T.) standard

- Extension of twt) pertOn crewing to all stations.

Substantial progress in mining was made in 1997 wj,h a totaJ of9 candidates participating in rhe E.M.l'. <raining which commenced at the Narionol Ambulonce School during the )'t"lr. A wide range of additional mtining was provided by the Board ond externally. This included bac;k core and lifting. refresher rraining for C.r.R. and higll levd driver rrnining.

Due to the n.uure of 1unbulance work. personnel come into conract with many aod varied cnemal agencies. To ~nsure Lh:u !lmbul:a..noe pt:rsonnel were aware of the funcrions <1nd capabilities of C<lch other. a number or intc:r-3gency crolning initiacivtS were undcrrakcn.

Ambulance pusonnel puricip;ncd 1n a rescue cx.crcl~ with the ~w of lhe nav:U ves.<;c:l. L£. Orb.; enrr:mt.S 10 cht' Emt'rgency Medical Tcchnici;m courSe wer~ .stcondcd rQ the Gouda Siochana and the Limerick City Fire and Rescue Bri&3de; rhc in-$Crvice in,'lttuctor and thr~ work based ass.essors WtJ'fl' involved in a general pracririoncr cardiac c.ue coufk Jnd gatdai srudenL'i were :~econded to che ~1mbula.nc~ service.

h w;a~ noc possible during 1997 to 1>rogres chc issue of PNO person Cf't'"1ing due eo financial and other circuntsr.ances. This ha.;; been targeu.'CI olS 3 priority for 1998 in the Limerick, Ennis and N('_oagb ambulance stations.

•

activation and response ttmes

At.U\Inion ;and mpon.\t' rime. compJIT vc::ry r~n·our.ablc wilh rhe n.t•o····l. s .. I. . . · ·1 bl · d' h · 'v•- .v<rag<:. ClWlk.a onlormau~n

11~.u J. c tn 1c.u~~ t ;)t C• l% of .all tmt'rgt:ncy caJh; were .JCtiv-At ~ 1n 1 . h· h · · · , Y' L • • 2 t I , ( CS!; I !lft f f'te ffiiOU[f!ll. fnC' ft.lfiOOitJ

lher Jge ror tnl\ 1.) 4 ~- ? ~ lu of urb~ cmeroenc1e."' Wl!f't ~1.,.uu.t--• , .- h •...t. • · -.1.1

, _1

~ r· "-' .o wu an t."'tv•f mmurcs of oi<;.tl\'.itlun le RJJI(1 U41 .avcrag(' ''* (,tt("tt. 91% or urbao cmc:_ruroncies in tfk rr'lriim W"',. ~ dcd · h f '

r . . n ' ·a- -ll· ..... ·--···-" ro wn Jn CJunc:cn mJnUlC$ 0 ;.u;.ll\"lUon. 1C" n.mun:al avct~t! I)~-

key activ1ty data

l,o~cicnu C.ttrit'd I mergency Call' RouoJne Coils

,\8,(,(,)

7,00,\ .\0,.]80

QUAliTY INITIATIVES AND DUTCOM£ STUDIES

A, lW' or th< Arute H"""'"' .. nsoing prognmme of dc.doptllft -ico IU"""' th< highnr qu.liry of \I.;&~. ;m t"Xtt'ru.i\'C' I';UK'Of .~ti•f.K:Uc>n Survq l'...U undctr~krn dtmng 1997. &rimts• '11 ~" wn'C'

""'•mm«! on the fOllowing ohrtt key "'r«'> of oht hospu.J oll<)' mmdal.

Phy>ical Srrucrurc Schcd ul in g l)irccr Care

• w:ud IJyout •nd deeororion waiting cimc- for :appoinuucnc; COnlrOI of po.tn

Overall the results of tho< "'"•Y were gencr.ally ,..., posin'< •nd rcOmed .lit ongoing hrgh bd of Utuf'anioo with dir<ct "'"' .-d uurmcno ....m·<d from ho<roul <toff They .00 ckmoruorued daily ccra.an issutt ausing di(Qu'r~cton ""tUcb tud eo be add~-

COMPLAINTS

The Acur~ Service opt rates :.1 pro--.a~..:uve compLaints p~ul't', Outing I ()97 a toral of 498 wrincn and V('rhaJ corn pi :tints 'A't'rt rccdved. 92% of rhcsc we~ ad.nuwlrdgrtl w11h1n ~en d:ays:.

rhC' Kr.·icc: opa-ares a ra.rgt-r of in\'ntigating iltld issujng finaJ ropon4C\ tO 80% of aU complainn: Wlthm a 35 doy lomi<. During 1997. 82% of >11 compbonu ""'"' dc:~h ""h wiohon oht 35 days. Of the lll'.'o nm mpondcd <o within 35 <by., the predomuw11 cause for rht .kb)· "" eirhtr rht complaioy of oht cootpi.J.mt or the reln-an1 ,tatf from ~itom reports ·~rt' raruuai to 1\),U(' rrsponsc being ~"'~Y on Ww 01

on nJght duoy.

CENTRAL STORES

During 1997. the dcvclopmem of J ~n[raf Purch,sing, WudwuJing .tnd Disuibucinn Spttm ~ '" Umcrick and Ertnis conrinun.l. Con.sider.tble saaiF craining wa< c:.tnittl our !iO 1.\ c·o impi'O'o't' CUi•um<"r uci~facUon.

Tbe purdl:&>ing funaion h.. """' b«n csublisbcd 25 a ,q>ar.~•< unn in ..:conbnce ,.;th rcwmmmd.otoon> of the ourionol srudy on nult'ri.!s ourug<mmL A 1'0" oi ~n.ol \t.ucrioh \blugtt hod bcm ,.j...,iwd •nd •ppi~C~rions ,.~under comidcr.IIIOO 01 th< end o( 1997 ,.;,h 1 •ocw <o moki"l! an appoonomnu on I 99~.

I

64 65 66 67

69 1 11 T2

• t

Corporate Services 60 61

&dintl Thirtrm ANNUAL RfPORI 1997

Personn el

The Board os one of the largest employers rn the ModWest Regoon woth over 4,000 stall 111 excess of 200 grades, rn approxomately 120 locatoons.

:he year saw further slcps towards a shoft In emphasos on tile role of the Human Resource onctoon, from ots tradohonal and largely centrahud one of servoce adVIce and f~ncllonal

guodance to a more slrategoc role to forge closer lonks woth the Board's Corporate ob,ectoves

~hunng 1997, consoderable proaress was made on the development ol a People Strategy, d rough the collectove efforts of a number of staff representone a varoety of professoons and

5•scopltnes across the Board. The Board's Corporate Strategy and Corporate Qualoiy tatement, whoch outloned a new approach to servoce delivery woth greater parhctpatoon and

onvolvement ol service provoders and users also rndocated a commotment to change on ma ' nagement processes and most Importantly, 111 ossues relatmg to people Thos. on turn ere ' ated a need for change from tradltoonal personnel admlnostratoon to a more strateeoc approach by the Board to the management of Its people to achoeve closer cohesoon wrth the

overall strategic objectoveS'·Of the Board

strategec ObJecteves

li>t fon'" tlirr.non •w ulnmfirtl •• ·· • Th< xhi<v<m<nt of o~isauonal n<:<il<n•• throusJ• poople. • l'M faciloarion of th< clunt;t man.gtment pnx:c» .,mcd " m...sur:able improvemcm in hahh •nd

soce>l g;a;n. . _ . • TM d..'tlopm<nt of • a>ntinuou< •mpi'O\'Cmmt ethos foc:u><d on p<Mn-«:ntrcd ckh•~ry of"'"'"'·

Cnr~r.~lr• rl.u ""' thr t/,.d,p,..rnt •"" rmpltmmtdllon •f a I'Mpk StmlltJ u1tirh uot~uU k • oqf&K dn''<" - t....cd on trust .md mpca for people - ~rounded •n th< ~u< ,,.tem<nt - .oJ,gnc.t,.ith th< ob,«nva of th< Bo,.,d) Corpo"'« Smtcgy ;md Corpo,.,. Quality S.at<mtnt • tnt<gntcd "ith the ptOCC<\ of Cnrporau: Strmg~e Manag<m<nt

key developments

- A dnl\ 1\:npl< Strategy w•, pt<pucd.

ldtnrifled priorities 11\dudc: tht further devolution of personnel ts.~Ul:S" 10 line man:agemem and a ch:mgang role for the central Per~onnd Oep.uunr:nt.

l he clement~ of g rccruimu:~nt plan wc:rc: ic.lc:mified for tmplcmenration based on agreed priori de.<.

Th~ turrenc WT~ recordinglrcpo• tins :;ysrtm was revit:wc:d 11.0d upgr-Jded within rhe limital ions of ni«ing <«hnololl)'• p<nding the installation of the o('W national t'Ompureriscd p<IS()nnd/payroll system.

• A numh<r of llc>lth and ~>f<ty initiotivts were unden•ken in Acute Services, Mental Health and FJderly 'im-ico and Community C. re.

£2.16-olm wu .. p<ndcd on soa/T de-·elopmcm and training.

A P•lot llcxi!ime •niuati"e wu inuodu<cd for the llo.,-d's suff in the Central Offie<s and in Unit 3. St. c.m,u.,; Ho.rnal. h IS <>p<ratins ~dsf>c<orily and will he R:Vitwcd during 1998.

• !Mip<r:annwrion Sui\' Rd..uo .... Rro-umn<nt and Tninins files wen: mia-ofilmed during 1997.

· n.. «>mput<rucd 'Y'«m fO< I'<'<Ord•ng of ''""ia: and aladarion of supaannuation cntidemems ,.., enhanced

' n.. 0..-cupa~!Onal H<alth Smttt performed 162 prt:-.,mploym<nt 5eremings for O<:W m<mb<rs of sail Thu '"'""" d..-d.>p•ng •nd W>ll •honly cs.pand to induck r<gu1ar sc.....Ung. immunisation and fo41.Jw up of""'"'« •u/T .ud ro pi'OVIdc •• odvioory -crvicc: on health and safory issues.

· ~"'.J:'' <<>ntnbut•>tl ..._. rnodc b) th< &.1\1 to the production of a policy document for all Health bo.n "" H<p~tn" B k~n•nr; •nd nnmunis;uion for bealrhc:;trt: worke,._ The policy docum<o< ha.'

•pp«M<J by th< Clue( fJ<a:utive Offi<m for implcmenouion in Health Boards.

~< ll:,.,nnel D.p.mment m.kle <omidc,.blc input to th< P"'paration of docum<narion for the " R<cm<nt 'lnd rroturtment of. cornpute<ued p<t>Onnd and payroll system.

I he lloord w:IS aaivdy involved wnh the Office fa< Hc:>lth ~bn>g<m<nt 10 Mn> such.,.. • p~rt1cipation in txcrcisei ro tdtmify key oompcrcnc.in for le:tdC'rs • f'.lcilirating mulci-Uisciplin;\f)' work$hops • pt·oviding adminisrracivc napport in rcl.u.ion ro the clisseminarion ofinrorm.uioJt • sc:locting canrud.ttcs • deve-loping planning filr 1 he l.c;ac.ler,hip ProgrunrnC'S

• TI>< lloord conrributtd OS,OOO to the setting up of the Hc:>lth x"'i<o Empl.,-.. Ag<nq anJ h .. tvrn ><h•·dy in,ol. ed in th< Agen<y\ op<ration> through m<n•~htp <>f the Hunun Raoun:c M.orugmmt Committee, pvtidp.nion in m;an~..:mcm tcalt\5 .Jt n.nion;alncguu.uiuns ;and dnt"DtC ,.., Nciotu! crircri.l and guidtints.

During 1997 considerable progre<o< was m•de on <he prcpantion nf' 1\t>plc Su-u'!t" b:btd on the Furupc:an Foundation for Qtaality M:1n~entent, Business ExCC"IIcnt:c Model. A Mtattgic I fumln R.csourcr Manage!1Tlenc group \vt~) formed. con$isting of key prrsonncl from .1 va.ri~ry of pm~''on~ .and locations duoughout the Bo.ud. who panicipatcd in Mllf asseumcm l't'Jc.urcb un organ.isaclon.al pcrforman<e in their !"'<lieu I,., • ....., of activity. The Pe<>ple SrrJt'!t" woll be t..Ompleted in early 1'1'18.

Recognising the nt<d for outcome •tudics and impaa """'"""'t on • nunlh<t of mas. on<hldon~ >Uif dn-dopmcnt and training. corutdcnbk woli< ..... c:vricd nut in the rr~ of. '"'"'"' n«J, an.olysis for Grade rv·. and rbc rrov..ion of. OUnagt'tnrnt ckwlo>pm<nt prop:;unme for eh .. 5"""1' In coUabonuon witb the Unovcntty of l..imch<k.

An tmpact asses.trnent carried out with rhe co--opcnlion of poucid~nt' md their supavbon tnJ~nl tM beneficial effectS of the I rUining progr;llnRlC. Jr is proposed tO follow tlm format o( ntedJ ;J;nJtyr.t(, impac1 evaluarion/ass<.-s!!men1 l~"lr future •rt;u1.agemcm dtvdopmcm c::muM:!o.

Rccruirmcm • 60 public competutOIU were hdd for which there wm: ),300 applicum A toul ttl J I! pennmcm appoinrmt-1\U \l,'t.rt mac:k.

98 training"""""' """ otpnl.lcd acntnlly during the ycar. In .oddouon thctt ,. ... • m.> I"' 101"" ol 0\'<f

four months involving all stoiT in the tkv<lopmcrn. destgn and O<Joi"IW._ of • Eusopa• ..,.~...,_ mc<ting md conference (IIOPF.) hOS<ed by this <Ounny and attended by JSQ halrban: ptofr.......h on ., variety of disciplines from 21 c:oumries.

'1"1 · · 1 · · • 'run1 • .,. rdarrd •nd rll hc>hh te Personnel Oeparrment proccs~d supc-rannuant~n emu t-mentt .Ul•unti 11 -n-

rtlirtments, resignations, deathJ, the upcl;uing and maimenaACC u( lCn"fcc rteortfs.. tae'.lf'Ch .m.J inrorma1ion on e.nridcmcncs. including AVCs, WidoW~ & Oqlh~n' bcncli1~o. et~., '" ropt.'D.I(' w numerous inquiries from .na.fT.

I c . rr • • • • ,_, .L •• rrod · of L. ,.•- llc>tttm< 1nuwm-. n>~~~r.butJo"" hi tht n .x.ur Rdauons. act:Jvrue~andu<JCU UK an ucnon lnc ,. . .IU'I

Working Commintt on Hepatiri. 8 policy ;wd the ompkmnn••••n of tknal n:snuaunns >C'"~~ . nd - .. .oJo, '-<""" .... ••< --N<.arly 300 long «rrn t<mponry .u/T. on bo<h nur:ung a non nu,.. . .,. ..

P<<t110n<ntly appoinred following nauon.cl and loal ogm:mcnu on ~"'&ram mnpomy '""~

4

62 64

Fmance

0.., Boanf1 finan.:ul posi<ioo at the md of O.Umhcr 19')7 (subject to audit) shows a cumu4twc .,..,.. •pmd t>f appro.Umatdy £725,000. lnclucl<d on thU arc ,_,..,uns on dcmand-lod schclllC$ (L6J4.000) and wpcrannuation (£258,000).

11tc Boanl h:n r=ivcd assuranca from ohc Dcpanmcl\f of Hddt tlm additional funding -.oil he fl""'"kJ tO cover thCK 0\'er·runs. However, until such time 1u 1hc funding is ncrually finalised anc.l1uuvid~l. prudcna: dicl'3.rts tluu the Board does not bl'ing ic into accoun1.

If dtc arrears arc uldmarcly fillly fund«!. dtc Board's r<Vi""d posirion would show a surplus of L167,()()() carried forward.

reported financial posit ion:

I m Alloaoion P.lOC'nt II'KOtne

P.yroll Deduruons s.ks and Oohcr Income

Deflcir for ohc ytar Dclicio bmugho forward from year end '96

Dcft<it arricd forw.ttd (cumulative)

source of tncom e:

1997Ait_,_ l':o umt lnc:otn< l':oymll Dcductoons Sako and Other --exp endi ture by care groups :

-Acuoe S.tvias Mcnoal Hcallh Ekkrly C.,., Communny C.,., Central & Other s.mc.,. •

lncom~

IR!m

14U 9.4 3.8 ~.3

163.8

14S.3m 9.4m 3.8m 5.3m

69.4m 24.7m 20.6m 44.0m 5.7m

Pay Kon Pay

ExpcndiiUt< IJUm

105.6 58.8

0.6 0. 1

0.7

gross expenditure in broad rcrms;

Non l'ay l'ay

36% 64%

The largen categories of pay were:

Nursing M<dkal/Demal P..tF.Jmedic:s Superaunu.atil)n

IRJ:M 44.3 16.3 82 8.9

a,cc:oundng. together fo t 74% of tOlal pay expenditure

Sot'ne of the larger items of non~pay wcte:

Drugs .and medicines Medic.illsu'l;ical supplios Grants ro volumary 3gcncies Capitatjon payments Cornmunicy drug.s schemes

JR£M .3.8 6.0 4.2 92 7.5

Acc::ouncing tog<rber, for 52% <>f toral non pay expendiourt.

key developments

M l .Vest~ro H ~a th Boa•o

A oompl~:.rc re-.·i~· _ha.o;: been carried our of the Board'~> acwunting and cost crrmr Jt.rUCfU.rr with 2 view to rhe provL'\ion of more accurate and derailed financiaJ int'Orrn:uion, enlunc:Af budgeuuy control ud a move cowards accou.oring for expenditure in rcnns of c;~re groups.

This was followed by prepornion for implememarion of an enlwl«d version of dlc cum:nr Gcncnl Wgcr and Management Reporting software ro F,cilit.ne thr mO\'e to r.be new ~undng ttnaenu~,

l'repar.nion for the implcmemarion of che Prompt Paymcms of Accounu Act I 997.

lllis was a major projc:ct and involved significto[ changes r.o sy.st<:rru and proudures · as wdl.u 11 m.ator OOIJcation and cr.aining programme-.

10, Bo•rds l997 Scrvjce Plan alled for enhanced capobllirin in couing and performanoe molmlon"J. Lt order ro ~dlieve r.his the Finance Depattme.nc nc:cds in~ mltif\8 m line wirh the fe(;onm,c:ndatiom• of the Odoittt' &-Touche report. Out eo deby m implm~cn._.rion of thu rrpon :.:n.-. H.-Aich BC>:<rds general!}; and the rc>ultant lack of oddirion.ol fiwdrng. it h~ not been pm•blc to .dUm: dre increa.ed st:affing during 1997.

2 4 6 !!

10 l? 14 16 18 20 22 24 26 28 lO 32 ~4

16 38 ~0

42 44 46 48 50 S2 54 56 S8 6(

70 72

I l

7 9 I, 13 15 17 1l il £3 2~

27 29 31 33 35 37 39 41 43 45 47 49 ~I

~l

r;s ~7

59 •

Management Services

st rateg1 c object1ves

The nm~c objcctn"<• of th< ~t.~gcm<nt.S<':"ias D<partm<n< f~ upon proce.s imp""~<nt duouP,ou1 tb< O!l(.,;;.uon 1n ordtr 10 re>lo"' ompro•od l.,e(, of efficocncy ~ <lf<c:m<n<$1. ~h<-

r l ' · ·r. hwlo<>v ""'"" mw.rd> <upporring me Boards Corpowe Bwi=• S<r•t~ ~cmcot o momU;ttOn tt- -~ o-- ( Board' h · J .,d ~ I'Luu: dte pnn>,iun of •n indq><ndrnt and rontinuou.< appr2i»l 0 the s n>n<.l.l • ocrounting :and 00>10<\> amvi<o<> throuP, in<<rnal audit.

ORGANISATION AND METHODS

1ssues and developments

Th< 0 & M lJni! con<nbuood to a nounl><r of d"·dopn><ms durmg 1997, ondudiog:­- communic.1Uoru inuia.uvcs rdating to MiCf'M'.· .... --e ~("('WOrlcing - ·ldecom F.ircann' Vinoull'rov<« 'lttworlld\Cillc li>r relephony - rc:vl('W of •dcrbollt switJ\bo.l.rd opcraulm~

cbe jti,~mc:nt of contr.acu for lq;al \trvic.cs d lhc Unplcmcntarion of 4 computtri~ loloi lime sysccm fi•r administrJtive StafT :1( C.entr31 Offices :m at Unit3, St. Camillus' Hospi<al purch;&.Sing rcvtew~

• n:view or prinung amngcntcnt.~ research on docurncm imaging tcdutolugy

• review or I (Qilh Uo;~rd .l(lCOtnmod;uion orrongcmcnt 'i wid}jn l .imeric.k Ciry.

freedom of Information act

Tow.uds the end of 11)<)7. thr Chief ll><eutiv< Officer appointed •n internal group. lod by the . Orpnisalions & '-~•11oodl OAkcr. 10 prcpar< the lloard for implementation of the Freedom of lnror~J<IOD Act From Ocoobtr 1998. ln lin< with ohis iniriari,·c, !he 0 & M Unit was renamed me Corporatt: ProJ<US Uo11. lu >n uutgtoi part of ohe pr<pJnuory proas. tor compliance by the Board with the Freedom uf. ln£orm.uion AA:..t, the Ch.tcfllxn:utive om,cr hJS tthn rhe opport1tnicy to inili:.tte ~wider comot PJ()I«l "ilKh "ill nwunc tlot llo.Jrd's proceues to the fullest e>~cnt wirh the obje<:tivc of introducing 'beit practocc aod "'''' fntndly proccdurco gr.on:d <owards pnwid;ng a qwli<y service to the gcncr.tl publoc. Th< nst ProportiOn of the r«ou- of ohe Co..porot< S.n>kcs Unit will be dediated to this PWJ><l"" nght through 1998

INFORMATION TECHNOlOGY

lhc ~rd <ootonuo 10 <n&l&< Information T«hnology •n the planning, deli,·ery and revi<:w of it> S<f"i<G. Tu this <n.l. th.llo•nh l I' Unu, <uppo<rod moli>.k>wing durint; 1997:·

data networks

l'hC' U-NnJ ll(IW opc::t~t~ ;~n C'-P:tl\\l\'t .and growing da1a network which include:.~ all uf our m:ain ~ito throttshout thr thrtt coun,_~ Currcnrl). an oc:m of 60 sites :uc nerworked. Maoagemc.nc of this ocrwo~ "1•~-1) p<'<fonnt:\1 froon C.cnor2l Offioes via nnwori< manatement >aftw:orc. The nerwotl< und.rgoe< conunouu_, (h..tngt ;I) further Mte'\ lre added and .~~ the compmer user popularion increases. P~ntly. thcrt .trc m ClU,C'\\ uf t .300 U\Cf\ lloarJ .. Witit.

on -g oing support and maintenance

A suhsumiaJ p_roJ>?rrion of the available manpower is rcquirl-d tO supporr and mainuiu installed ~echnology wl'llch m dude n~works. hardware, 5oftw.,re and compurt'f applk:ation.s. In $ummary. these mclude:

· Wide Ar<>< and Local Area NetWOrl:s

· E~"":prisc Servers loc;ued C<:nrrally or Ccmrnl Offioo; and ar the Regional Ho•pitol Lilllerick and D•smbuttd Servers al Ennisoand Nenagh.

•

~ Approxim:udy 1,300 user worksr.uiorui, i.e. a combin~ion of perwo.a.l corn pure~ and dumb tmnin:a.ls.

• I nstolled applic:nions, including a l'•rienr Admini><rarion System (Acute and other Hospiuls/Horn<;s)J Mcnr:rl Health (c~nictllr focused) System Board \lido; Medi,,.J C.o.rd Rcgismuion S)"cem &.rJ wide:; a range of Financial Sy<tcms Board wide, including Pa}TOII, General Ledger, Accoums l';oyobk, Surutory Allowances, Cheque Reconcili.rion, Suppbnenrar:y WdF.tre :l!ld Stores I Purch.sing.

· A rnose of other applications arc also supported. including, Radiology. LJObor.>tory. Telemdrology, Ph:lrm.acy, Computer J\jc.fed Drawing, FJexi-Time. Pacients' Priw.re Pro~ny; a range of Commutury C:1rc s~tems. including Clienr Index, Birth &-gisn-.acion. ChiJd Immunisation and a Disabilities Rt:guttt

key deve l opments

A pmcuremem (EU negotiated procedure) for an inrcgrared Hospit.tl uborarory lnfurnution System fur rhc Board commenced during 1997. Contracts will be rondudcd !><fore mld-1998 ood significant implementation will be achieved befOre tbc end of J 998.

A Radiorogy Information Sysrcm was procuud cowards the end of 1997 :md impfern~uation ls ai»ua to conun~ncc ar Ncnagi• General HospicaJ and r.h.is will 1x fo llov.·cd. in due oour.L by implcmtru:<Uion ~ the Re~rional Hospir>l Limerick, Resional Onhopacdic Hospir.d CJOQnl and Ennii G<ntralliospital.

· An Accideur & Emergency System for ~"' Regional Hospiral Limerick was procured toword1 the end o(

1997 · implemenrarion, which is p=ntly being planned, \\ill take pb« during 1998.

Information Teclmology_, worldwide, i:; c:unenrJy rhc focus of ntuclt :mention zand invuuncm in order eo ensure ch:at it will remain Rrvicable into the new miUc:nnium. In tills n::g;ud, it &igni6anl f»k Wlll

undertaken by rhe Board during 1997 in Qrd<t to idemify technology d<111<n11 (bardw>rt. sofrwm: ;and nerworks} which were not Year 2000 compliant and which, conscqutndy. would tequirr trar6cuion ur replaccrneor. Where appropriate. reclificuion works "'o.cre initiated and replaccmt:na ~ pbnncd.

The Midland and Mid-Wcsrem Health Boards ba•'< ro-opcrarcd dosdy in th< rkvdopm<Ot of Community Care Information Syswn<. During 1997. devdopmtJrr I implena<tltation mdudcd M.,t<'f Oienr Index, Birda R%isrration & Child lmmw>isation SystemJ. Also, P"'''mtory wotl< fOr rk-<:lopmmt of • Child Care (sod;d work) sysr<m commenced during 1997 and it i1 esp«ted that • ~ ,.,IJ I>< inrplernonred by thi< Board during the latter half of 1998.

· The Board made signifitotu progress with reg:ord 10 Otctronic Mail during 1997. npt<i.ally •• C...ml Off'tc~. Progress was ~so n1ade in pro~rlding mJf wirh lnc~rn~ !ICC'f:SS for ~h purpncs.

• "fhe \':IS! amounr of prcparawry worlc n<C<SSOry tO n:placc the Bo>nl:S G<ilerol Lcdg<r S,..cm ,. ... wrdt•rrake., in 1997. The new ledger wnl b. impl<111enr«< in April 1998.

4

4 4

66 67

I

I ~

pers onnel, pay r ol l, atte n da nc e monitor1n g and control, re cruitment and supe ran nuati o r protec t ( PPA RS J

'l'he Health Boards and Se. lames' llospital Oublin arc joint ponicipants in che l'"'"'""'"ent of o PPA~ inrtgrated system. Siguificant progress Y.".tS made during 1997 with rht procurc:mc:nt ( E.U ncgCJtiJccd procedure) and c;ontmc;t nct.'tnl:uiQn.•. were at an adt,anccd ~tJ.gc by yrar end.

com puter hel p/serv1c e de sk

·lne I.T. Uruc op<f'""' a onltr.oli....S Hdp I Service Desk which provid<S services fur compu«r "''"" throughoU! the llo>rd. Ouring 1997, the Desk recorded in e>Ce<> of 3.600 call< of whtcl> 8 remained open ~r }rtr end.

compute r training

- Extensive uaining on compu«r >pplic:nions by <he Board's I.T. personnel and application dcvclopcn (at:emal) W>S provided.

• Traming on PC dcslrtop produru such as Miaosoli Off.u •nd F.-Mail was provided. 271 sr.tfT mcmbt.-rs attmded courses ID chc 1\oarcl's Mmpuccr mining focilil)' ar Onu:tl Office.

- Tcchnietl mining w.s provided for the Board's 1:1: per<unnd.

INTE RNAl AUD IT

Th(' Board$ (nttroal Auclit Unit is .uaA~d by an ln:crna.l Audiror and rwo a<sist;a.ms. The Internal Audiwr t<pons cLrm!y <o cht Chief Fl(((Utivc Officer on mauet> r<bring '" •udit planning ;tnd n:porting. The •ndcptndan of cht audtt funaion is <hereby pn:sen·<d.

The ln<cnW Auditor .onductod and <<p<>rtcd upon 46 Audiu du<ing 1997. The range or audirs cunductcd W>S broad, focusing on a wide spectrum of the Boan:l', activitio across all of tltc Program m~ •nd Funajonal Dep~.nmcnu.

•

•

•

•

•

Technical Services

In 1997 che ]C.hnje.J Sc<vic .. Ocp.truncnc ""' mvohcd cn m>nv differ<m.,..., including: .. m;untctUncc • nujor ~nd minor capimllre:fwbishm~t work.\

macntenance works

Mnintcn~Ul<'C works were carried out in all ar~as, u,..ing the 1~1lar maimcnaucc sraff and conrmctort. ~c.1fT aoc conco.cli>c-d in CIJrc and North 1ippcr><y whidc givt$ Acxibilicy in cxccuciog works, and are deployed followmg di\OiiSiom bc:twee:n the respe'Cfive S\lptrVI\('Ir\, Lou.l Man~ement and cbc Techmcal Sconicn

Officer (1:~0) wher< appropriare.

In I >ncwd<. <..Ware primarily aligned by cr.><!uoonal progr.mmo. 'Thert IS coocinoous 1110\Tm<nf be<wttn prognmmcs an<lloacions dq>ending on pnorori<s. conscquenc on cfucm.sioos ba"cen .S..P"r¥1Wn. che l«hni<al !>enito Officer and focal manag<mcnc Th" mMrmenc and the uucgracion of the l'<'piW >1aff with contr.t<COr> h.u enabled many worl<> co be luccn,fully compkced.

MAJOR CAPITAl WORKS

Rogional Hospital - Ph= I and fl P.1nid 1><ltion i,, Project Trams. Project M:}n:agen1ent 11nd procts~•ng o( capiul d.ums.

~I he Tcchnk.aJ Services Deparm1cn£ provided a complccc inFhome 1>rojt.'Cl :.ervice for 1hc following;

Regional Hospital - Ph:ose fiA Pharmacy MedicaJ Rc.:ords- in oonjuocrion wid> Dcsogn Team. Ctrdiolugy Unic Ward 20 Sc•ndby Gcncr.uor IMI21btion - .. ;,h D<s~ leam

R<gionol Mattmiry Hoopital: Neo N>t•l W•td

R<gional Onhopaedic Hospital: St. Jooeph'• ~.nl

Ctncnl Ho.pirol, Nenagb: lknr.tl Clinia

- St. Mory .. , 1'hurlc.: Day unuc

- Ballylandera & llroadlord Health C.nu .. : Refurh"hmenc •nd bcceusion

~ Smnd llou..., & Bd6dd House: Rcotd<nce and ll•y Ccntn:

a.recastl.-: O.v Can: Centre

Sou1hdl H<alch Ceoue: P:anicipation cn che l'roJ«l Tcvn •nJ om('k_.. ...... of dw 1Jrt>u1mn.c of Health. \tr'l<!li< Managemcn• lniwc""< (~Mil on"''""'" co \toi(:P ~ ,nJ S of cht P"'JCCC1

\1tlford llospiee: bttruion propcct- P"""''P''"'" cn tbe ""*'' lum

O.usfccm or Chariry, Li>02!l'Y' Rtslden«< lur menc.dl) hanJKJprnl • f"""'l"'""' '" cht l'nojca

lC.tm

Kolru>h, Orchard Hotd Projecc Suppon ~ervctt "' r<ques•td.

Yoacional TNining Centre, Dooradoylo: \upp11r1 "'"""' .. ml""''ed·

68 69 ,

II INOR CAPITAL WORKS AHO_IIHUR_BISH MEHT WORKS

Or•"'"S' .ond >p«iiiacions p~r.d, r<n<lcn .ouP,c (;.here n:quiml) and projectS conrrolk.l.

F.nnu1ymon: RA:rubt~rarion Unir. Link C .. orridor on cl Orotory (with FAS)

R.httn, Co. Cbre: O.y C<nrrc (with FAS)

Kihn•llo..Jc O.y Centre (with FA$)

Dean Mw\'dl Home., Roscrea: Conrracror op1,,,inh.:d

l'orkh<g Hou><:, Cahcnhvin; SWf AccommO<btion

• S. hi" W>rd 10 rdUrbishmcnt, Lift lmr>ll>cion (" nh Comulnng Engineers)

Cmual Ollicts: ('.omputer Room

S.. J<>«ph's. Ennis; !Gtch<n upgradro, Uniu S 11£ 6 rcf"urbi>hmcnt

R'l'on:tl Hospiw : Ellabling, O<eannng Work. for Phase I and ll.

REGIONAL HOSPITAL, ENABliNG, DECANTIN G WORKS f OR P HASE I AND 11

'I he f<>llowong worh ""'" noo.-.sS3ry ro ;tlluw f'h"sc I and l'h"'c 11 10 procc<::d. These were prillmily carried out by the Boarcf; ma.imcnan~ staff.

• il.nnoo-:tl ofX.JUy Unit from A & E Oc-p.nmcnt

· R.clo<:a,.,., of C.. Son ro lloanlroom

• Pru.....,n of offiC<O and rewiring in the old nuncs home

· "''"'"IOn of offices and Oocton n:sidcnces '" the old Convcnl

• lnmlling and hrring out of ponacabins

• \tl\l<tnr•l ch.rnges in the Lahor:uory

• Rdowron of l':ocdiltrics •nd re-arranging of ~\ud1 1A •nd I C

• RdnuriOn of l..uodry storage area

Rdoar••n of Ourpui<tlts Oq>anmcnr to new buildrng

contracts •ssued ' " 1997

llrcn: "<I< 1 OS eo rd ntl".tetS <lW'.t ed to 87 C()ntt;~uors.

FIRE AN D S,AfETl._

Preparation of specification, tc:nd~r dOtutn(:fH:Jri(>n and i nst:tJiation of a Dt\V fire alarm and emergency lighting >}'$ti!m ar Rahccn Dimicr I lospiral.

- The: programme of cr:.Uojng in fire .safety is primarily for st:.ft worldog in residendal car~ areas. The nbjeCLive is to u·ain :IS many people as- possible, indudi,ng pcrmanC'nc night sr.aff. A cocal.of l ,J 09 people ~trt:ndrtl $f:!'l.~ion.s: io I 9.97.

_j_AFETY, HEALT H AND WELFARE AT WO RK

- i\'iost areas have c.smblishcd safety commirrccs -which arc the m~ in oonsult<t.c-.ive forum for ~ea« on health and saicry matters. In pur and prac<ical guidance on healdl and safety macrc11< is provided by the Fire and Saicry Officer.

• The. ongoing updating of rhe safety sraremcnts cominu<Xi, including the revi$ion of hospital statements. dc:;paruncnc srarement.s and s:tre work practice sheets.

Nwnetou$ s.:lfCry audits of workp1accs \'lCfC u.ndcrtak('n by the Pirt and Safecy Officer

KEY DEVELOPME NTS

• The Technical Services Department parricipated in Mid-West Major Emergengr Planning Projocr and an rmcrdeparonentaJ \\'orlclng Group OJ' pc:.1Cf tirne Emergency Plaruling.

- An in.-house craining programme cornmcncod for maintenance staff.

- Autocad was imroduetd in ilie Drawing Office.

.. F..ner{;)' consumprion was monjrored and mccdngs were held with the ESB 10 set up a ccnrral MUing $)'Stem.

- The clinical w.t.~u:: disposal concract was monirored.

· The Housing Aid for the Elderly Scheme was supervi><d.

· Work commenced on the Tdccommunications VirruaJ Private Network (VPN) Projm.

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MID · WESTERN HEALTH BOARD

31/33 Catller;ne Street, L•menck Telephone 061 316655 FKSmle 061 483211

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