INHA Policy and Action – IRELAND

POSITIVE STEPS FOR PREMATURITY

In 2011 Ireland’s inaugural benchmarking report on prematurity was published. The report called “Positive Steps for Prematurity” was the result of the collaborative efforts of Healthcare Professionals working in the field of Neonatal Care in Ireland with contributions from our Director of Advocacy and Policy Making, Mandy Daly. The report mapped the landscape of prematurity in Ireland and 5 key recommendations were identified that would improve the care delivered to our preterm infants in Ireland.

These recommendations were:

  1. Develop and implement a targeted public policy on neonatal health, with the active engagement of healthcare professionals and parents.
  2. Increase general awareness of prematurity (its health, social and economic implications).
  3. Develop and implement a National Prevention and Screening Programme for high risk pregnancies.
  4. Take active measures to improve neonatal workforce education and neonatal units staffing in order to meet international standards.
  5. Extend the Neonatal Transport Programme to a 24 hr service to ensure adequate coverage and patient access to emergency and quality care as needed.

The report was included in the European Benchmarking Report “Too Little Too Late” published by the European Foundation for the Care of Newborn Infants (EFCNI).The report provides an overview on the impact of preterm birth across Europe and paints a compelling picture of the differences that exist in levels of care and the lack of national health strategies concerning maternal and newborn health.

CLICK HERE for this report from efcni.org

NATIONAL NEONATAL TRANSPORT SERVICE

The National Neonatal Transport Service is a rapid response service for the transport and stabilization of premature/ill neonates who require transfer to a tertiary centre for intensive specialized care. The aim of the programme is to bring to the point of retrieval a level of care akin to that of a neonatal tertiary centre. The first patient was transported in March 2001 and the service operated from 9am to 5 pm Monday- Friday.

The Irish benchmarking report “Positive Steps for Prematurity” in 2011, recommended that the neonatal transport service be extended to a 24 hour service.

The Neonatal Clinical Lead, Prof. John Murphy, National Maternity Hospital, the Neonatal Nurse Clinical Lead, Hilda Wall, National Maternity Hospital and Patient Representative, Mandy Daly (INHA) appeared before the Joint Oireachtas Committee for Health and Children in November 2012 to seek additional government funding to support the extension to the service. A 10 minute short film was produced by Mandy Daly with the financial assistance of an industry partner to support the campaign.

Screen shot Dr Rachel Power from video about the National Neonatal Transport Service. Clicking on this image will take you to a video is hosted on Vimeo and requires login to view.

CLICK HERE or on the image above to view video. Password to access is ‘keely2007

In December 2013 the National Neonatal Transport Programme extended the service to operate 24 hours a day Monday to Friday. A patient information leaflet was published in conjunction with the launch of the service.

Currently the INHA are working with the relevant stakeholders to implement a Retro-Transport Service which will see infants repatriated back to a hospital close to where their family live following treatment at a tertiary unit.

The following short film was made by the INHA for World Prematurity Day 2014 to highlight the need for the Retro-Transport Service.

Screen shot of blurred field background with foreground title 'THERE AND BACK, Stories of the Retro-Transfer Process'. Clicking on this image will take you to a video is hosted on Vimeo and requires login to view.

CLICK HERE or on the image above to view video. Password to access is ‘INHA

Collage of leaflet about the National Neonatal Transport Programme. Clicking on this image will download the leaflet in PDF format.

You can download a patient information leaflet by CLICKING HERE or on the image above.

PATIENT ADVOCATE WITH THE NATIONAL TRANSPORT MEDICINE PROGRAMME

In July 2013, the INHA were invited to join the National Transport Medicine Programme.

The primary objective of the National Transport Medicine Programme (NTMP) is to establish a comprehensive Retrieval/Transfer system for seriously ill babies, children and adults throughout Ireland. It is about getting the right patient, to the right care, in the right condition, in the right time and involves the timely Retrieval/Transfer of critically ill or severely injured patients by an appropriately trained and skilled team of health professionals.

The NTMP is funded by the HSE and brings together Critical Care, Anaesthesia, Emergency Medicine, Acute Medicine, Acute Surgery, Paediatrics, Obstetrics, Neonatology, Nursing and Midwifery, National Ambulance Service (NAS), Primary Care and Patients under a single programme structure. A Steering Committee is to be chaired by Dr Jeff Perring, Director of PICU, Sheffield Children’s Hospital. The Clinical Lead for the Transport Medicine Programme is Dr . The goal is to guide the development and implementation of a national Retrieval/Transfer system.

Retrieval involves a team travelling to the patient, stabilizing the patient and returning with them to the Hospital the team is based at, or other appropriate Hospital.

Transfer of a patient occurs from a referring to a receiving Hospital. Low acuity patients are transferred by NAS and by Private Ambulance services. Higher acuity patients are additionally accompanied by a Nurse, and when required a Physician, from the referring Hospital.

What is funded by the NTMP

National Neonatal Transport Programme (NNTP)

  • Establishment of a 24/7 service from Dublin – COMPLETED

Paediatric

  • Establishment of a Monday to Friday daytime service, congruent with the model of care for the National Paediatric Hospital

Adult

  • Expansion of Mobile Intensive Care Ambulance Service (MICAS) to 8 to 8, 7 days per week to operate from Dublin.
  • Establishment of an 8 to 8, 7 days per week service to operate from Cork and Galway.
  • Establishment of Intermediate Care (IC) Ambulances in Drogheda, Sligo, Castlebar, Limerick, Tralee, Bantry and Waterford.
  • Development of an Adult Transport Medicine Training Course.

What the National Transport Medicine Programme means for patients;

  • Enhanced access to high level health care services for a wider proportion of the population.
  • Safe Retrieval/Transfer of severely injured/critically ill patients for Critical Care and other specialist care in tertiary hospitals.
  • Enhanced clinical outcomes for severely injured / critically ill patients due to earlier appropriate decision to transfer, stabilisation prior to transport and specialised care en route.
  • Savings due to a reduction in Average Length of Stay (ALOS) for affected categories of patients across the Clinical Programmes.
  • Optimising utilisation of resources within the national health service.
  • Capital and regional based Retrieval teams/services will be an efficient and effective strategy for providing workforce support to regional and outlying hospitals.

PATIENT ADVOCATE WITH THE NEONATAL STRATEGIC GROUP MSc NURSING ADVANCED PRACTICE NEONATOLOGY

Since October 2011 we have had a representation on the Neonatal Strategic Group for the MSc Nursing Advanced Practice (Neonatology).

Following a proposal form the Neonatal division of the Department of Paediatrics in the RCSI, with the support of the Neonatal Subcommittee of the Faculty of Paediatrics of the Royal College of Physicians of Ireland to develop a programme in advanced practice for nurses working in the area of neonatology, this Masters in Nursing in advanced practice in Neonatology, the first of its kind in Ireland was developed by the Faculty of Nursing, RCSI in consultation with the strategy group set up for the programme. The Faculty of Nursing and Midwifery, RCSI were approached by a group comprising of consultant neonatologists and established advanced nurse practitioners in Neonatology to develop this programme. The Neonatology Strand is being delivered as part of the existing MSc Nursing /Midwifery (Advanced Practice) (Incorporating the Certificate in Nurse and Midwife Prescribing and Ionising Radiation X-Ray Module).

PATIENT REFERENCE GROUP MEMBER OF THE HSE NATIONAL ADVOCACY UNIT

In July 2013 the INHA were invited to join the Patient Reference Group of the HSE National Advocacy Unit.

The primary role of the National Advocacy Unit

  • To ensure that the involvement of service users is central to how health care services are designed, delivered and evaluated.
  • To develop and support implementation of best practice models of customer care within the health service.
  • To support implementation of the “National Healthcare Charter, You and Your Health Service” which outlines what service users can expect and what their responsibilities are whenever and wherever they use health services.
  • To develop organisational capacity, to gather patient feedback and to use this information to improve services for service users.
  • To encourage service user involvement on patient forums.
  • To support the development of a national network of patient safety champions.
  • To support implementation of advocacy programmes in health care settings.
  • To improve access to health services.
  • To promote clear communication between health care providers and patients following an adverse event in health services, and..
  • Mediation and facilitation for complaints handling.

PRIMARY EYECARE SERVICES STEERING GROUP

In 2014 the INHA joined the Primary Eye-care Services Steering Group who’s remit it is to review primary care ophthalmology services in Ireland. The objective of the Group is to review and update eye-care protocols, reduce waiting lists, improve access to services and reduce the incidence of inappropriate referrals.

The Primary Eyecare Services Steering Group report has been published and can be seen in full here: http://www.hse.ie/eng/services/publications/Primary/Eye-Services-Review-Group-Report.pdf

MODEL OF CARE FOR NEONATAL SERVICES IN IRELAND

Dr. John Murphy, National Neonatal Clinical Lead and Neonatologist at the National Maternity Hospital, Holles St, Dublin 2 launched the Model of Care for Neonatal Services in Ireland at the World Prematurity Day Medical Symposium hosted by the INHA in Dublin on November 13th 2015. The aim of the document is to describe the services that should be provided at each level of neonatal care nationally, to inform future service planning and developments and to eliminate duplication and fragmentation of services.

The INHA were delighted to have had the opportunity to contribute towards the content of this blueprint document which provided a vision for the future of neonatology in Ireland and described how this vision can be implemented.

Please click on this link to view the Model of Care for Neonatal Services in Ireland document.

PATIENT REFERENCE GROUP MEMBER FOR THE NEW CHILDRENS HOSPITAL

The INHA is a member of the Patient Reference Group for the New Children’s Hospital and engages with all relevant stakeholders to ensure that the new hospital meets the needs of all families and service users.

Advanced Paediatric Nurse Practitioner Critical Care Retrieval Steering Committee

In 2017, the INHA became a member of the Advanced Paediatric Nurse Practitioner Critical Care Retrieval Steering Committee, with reference to overseeing the development of the Advanced Nurse Practitioner Critical Care Retrieval Role for Paediatrics.

National Neonatal Therapeutic Hypothermia E-Register Development Working Group

In 2017 the INHA were invited to join the National Neonatal Therapeutic Hypothermia E- Register Development Working Group. The group under the governance of the National Clinical Programme for Paediatrics and Neonatology (NCPPN) in collaboration with the National Perinatal Epidemiology Centre has commenced work on the development of a National Neonatal Therapeutic E- Register. The work will be completed under the governance of the NCPPN chaired by Dr. John Murphy, National Neonatal Clinical Lead.

SERVICE USERS GROUP DEPT OF NURSING & MIDWIFERY

The INHA is a member of the Patient Reference Group for the development of a new Nursing and Midwifery Education Program with the Dept. of Nursing and Midwifery, Trinity College Dublin.

THE NATIONAL CHILDRENS HEALTHCARE CHARTER 2013

The National Healthcare Charter, which is titled You and Your Health Service was developed with input from many interested parties including representation from the Irish Neonatal Health Alliance, patient advocacy groups and individual advocates.

It is part of a series of quality improvement initiatives designed to involve service users in influencing the quality of healthcare in Ireland.

YOU AND YOUR HEALTH SERVICE – WHAT IS IT?

You and Your Health Service is a Statement of Commitment by the HSE describing what service users can expect when using health services in Ireland, and what they can do to help Irish health services to deliver more effective and safe services. It is based on eight principles which underpin high quality, people-centered care. These principles have been identified through a review of national and international patient charters and through wide consultation with the Irish public.

It aims to inform and empower individuals, families and communities to actively look after their own health and to influence the quality of healthcare in Ireland.

YOU AND YOUR HEALTH SERVICE – WHAT DOES IT DO?

  • It outlines supporting arrangements for a partnership of care between everyone involved in healthcare-patients/service users, families, carers and healthcare providers.
  • It supports a healthcare culture that delivers health and social care services in a predictable, preventative, personal and participatory way.
  • It recognizes that there are different roles and responsibilities for both service users and healthcare providers.
  • It promotes the importance of service users as individuals with diverse needs and not just a medical condition to be treated.
  • It applies to all public health and social care services, including community care services and acute hospital service.

Table showing various aspects of what parents and potential parents can expect from the Irish Health Service. 8 categories within 'expectations' are listed as well as suggestions on what parents can 'do to help'.

Source: www.hse.ie/eng/services/yourhealthservice/hcharter/National_Healthcare_Charter.pdf


BRINGING TO LIFE THE PATIENT EXPERIENCES IN PREMATURITY

In 2014, the “Bringing to Life The Patient Experiences in Prematurity” patient survey was conducted to highlight the gaps that continue to exist in the delivery of information and services to families affected by a preterm birth. The results of the survey were presented at the World Prematurity Day Event in November 2014.

Collage image of pages from the 'Bringing to Life Patient Experiences in Prematurity Survey 2014 Ireland'. Clicking on this image will download the Survey in PDF format.