Healthy Ireland Plan 2018 2023 - Community Healthcare East - HSE
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Community Healthcare East Healthy Ireland Plan 2018 - 2023 (Dublin South East, Dún Laoghaire & Wicklow)
Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
Contents
Forewords 3
Abbreviations and Acronyms 7
Section
1 Introduction to Healthy Ireland 9
Section 2 Overview of Community Healthcare East 13
2.1 Geography of Community Healthcare East 14
2.2 Population Profile 15
2.3 Population Health and Wellbeing 19
2.4 Governance and Leadership 22
2.5 Community Healthcare Networks 23
2.6 Workforce and Services 25
Section 3 Developing the Community Healthcare East Healthy Ireland Plan 29
3.1 Developing the Healthy Ireland Plan 30
3.2 Adopting a Life Course Approach 33
3.3 The Community Healthcare East Policy Priority Programmes 34
Section 4 Approach to Implementation 35
Section 5 Community Healthcare East Actions 39
5.1 Making Every Contact Count 40
5.2 Healthy Childhood 42
5.3 Healthy Eating Active Living 44
5.4 Mental Health and Wellbeing 46
5.5 Positive Ageing 48
5.6 Alcohol 50
5.7 Tobacco Free Ireland 52
5.8 Staff Health and Wellbeing 54
5.9 Self-Management Support 56
5.10 Sexual Health 58
Bibliography 61
Appendices 65
Appendix 1 Some Related Strategies and Policies 66
Appendix 2 Community Healthcare East Healthy Ireland Groups 68
Appendix 3 Staff Consultation Event 69
Appendix 4 Useful Links 70
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Community Healthcare East Healthy Ireland Plan 2018 - 2023
List of Tables
Table 2.1 The percentage population change nationally and in Community Healthcare East
in adults aged over 75 years 16
Table 2.2 The percentage population change nationally and in Community Healthcare East
in 20-35 year olds 16
Table 2.3 Births in Community Healthcare East in 2017 and 2018 16
Table 2.4 Immunisation uptake rate nationally and in Community Healthcare East 19
Table 2.5 Location and population of Community Healthcare Networks in Community
Healthcare East 23
Table 2.6 Community Healthcare East (CHO 6) and Section 38 staff breakdown (Dec 2018) 25
List of Figures
Figure 1.1 Social determinants of health (Adapted from Dahlgren and Whitehead, 1991) 10
Figure 1.2 HSE’s three priority areas for Healthy Ireland 11
Figure 2.1 Map of Community Healthcare Organisations, highlighting Community Healthcare
East (CHO 6) 14
Figure 2.2 Community Healthcare East (CHO 6) population as a percentage of the national
population 15
Figure 2.3 Community Healthcare East population breakdown by age and sex 15
Figure 2.4 Community Healthcare East population profile by nationality (Census 2016) 17
Figure 2.5 Pobal HP Deprivation Index of Community Healthcare East by small area
(Census 2016) 17
Figure 2.6 Mental/behavioural disorder diagnosis of emergency in-patient admission in those
with “no fixed abode” 2005-2014 18
Figure 2.7 Median age of mortality among homeless people by sex compared with population
life expectancy 18
Figure 2.8 Summary results from Healthy Ireland Surveys 2016, 2017 and 2018 20
Figure 2.9 Community Healthcare East governance structure 22
Figure 2.10 Community Healthcare Networks in Community Healthcare East 24
Figure 3.1 Life Course Icons 33
Figure 3.2 Implementing Healthy Ireland in Community Healthcare East 34
Figure 4.1 Principles for defining Community Healthcare East’s Healthy Ireland priorities 36
Figure 4.2 Governance structure providing oversight for the implementation of the Community
Healthcare East Healthy Ireland Plan 36
Figure 4.3 Some health information and data sources informing the development and 37
prioritisation of Community Healthcare East’s services
Figure 4.4 Some of Community Healthcare East’s strategic partners 37
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Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
Forewords
Joint foreword from the National Director Strategic Planning and
Transformation and the National Director Community Operations
Dr. Stephanie O’Keeffe Mr. David Walsh
National Director National Director
Strategic Planning and Transformation Community Operations
Health Service Executive Health Service Executive
The Department of Health led cross- and that over time will realise the vision of
governmental Healthy Ireland Framework is Healthy Ireland.
our national strategy for improved health and
wellbeing. Healthy Ireland brings together To deliver on this commitment within the
people and organisations from across the health service the HSE published its Healthy
country to address the social, economic and Ireland in the Health Services National
environmental factors that contribute to poor Implementation Plan. The Plan identified three
physical and mental health and to address strategic priorities - Systems Reform, Reducing
health inequalities. Healthy Ireland reflects the Burden of Chronic Disease and Staff Health
our shared commitment in the health sector, and Wellbeing. We are delighted that this HSE
and more widely, to support people to be as Community Healthcare East Healthy Ireland
healthy and well as they can. Implementation Plan has translated these
priority areas, into concrete, tangible actions
The Department of Health’s Sláintecare for delivery at local level that can make a real
Implementation Plan 2018 is seeking to embed difference for their population.
the principles of Healthy Ireland in the design
of all models of care so that they permeate This Healthy Ireland Implementation Plan builds
interactions between the health services and on the work already underway in Community
the public. It recognises the key leadership Healthcare East, and the strong partnerships
role the health system needs to continue to developed by them with external agencies,
play in driving this whole-system shift towards including collaborative working with Hospital
a culture that places greater emphasis and Groups, to improve the health and wellbeing
value on prevention and keeping people well, of their population. This plan includes 35 large
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Community Healthcare East Healthy Ireland Plan 2018 - 2023
scale actions identifying the pathway for to making major systemic and cultural shifts
service users, staff and partner organisations in how healthcare providers do their business.
in Community Healthcare East to work to We would also like to acknowledge the staff co-
further embed the health and wellbeing agenda ordinating and supporting this work locally and
in everything they do. The Plan recognises nationally, particularly Sarah McCormack, HSE
that their services and healthcare teams have National Healthy Ireland Lead, whose work in
enormous potential to influence the health and supporting the planning process and in forging
wellbeing of the people for whom they provide positive working relationships at national
day to day care and support. and local level strengthens our capability for
implementation.
We would like to take this opportunity to
commend the Community Healthcare East We wish Martina Queally, Chief Officer,
Healthy Ireland Steering Group, the CHO the Community Healthcare East team,
Management Team, in particular Martina and their partners, every success with the
Queally, Chief Officer, and Siobhan Fitzpatrick, implementation of this Healthy Ireland plan.
Head of Health and Wellbeing, and all their staff,
on the development of this Plan. The publication
of this plan shows their combined commitment
Dr. Stephanie O’Keeffe Mr. David Walsh
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Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
Foreword from Chief Officer
Ms. Martina Queally
Chief Officer
Community Healthcare East
Many factors influence the Health and The Health Service has a key strategic role
Wellbeing of the population – some factors are in supporting population health. Community
within the control of individuals and others are Healthcare East provides community health and
strongly determined by a range of external social care services promoting all individuals
influences. Promoting Health and Wellbeing having a healthy independent life. Promoting
in a whole population is complex and requires and supporting the health and wellbeing of the
collaborative intersectoral work. Strong staff is another key priority of this plan.
strategic alliances with other statutory services
and the third sector providers is necessary to The staff in Community Healthcare East
positively impact on the broad determinants of have championed many initiatives that have
health. provided the evidence base for some of the
programmes in the plan. I am looking forward
The Healthy Ireland Plan for Community to working with all our partners to support the
Healthcare East outlines a broad and ambitious implementation of this plan.
range of evidence based programmes that
will be led by the Head of Service for Health
and Wellbeing and supported by all staff. The
plan builds on a solid foundation of strong
partnership working with other agencies in this
area.
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Community Healthcare East Healthy Ireland Plan 2018 - 2023
Foreword from Head of Health and Wellbeing
Ms. Siobhan Fitzpatrick
Head of Service, Health and Wellbeing
Community Healthcare East
The development of this plan has been enablers to equip members of our population and
underpinned by the Government’s Framework our staff with the knowledge and skills to sustain
for Improved Health and Wellbeing 2013 – a healthy disposition to ageing well, whether by
2025, which aims to achieve improved health promoting healthier choices or by helping people
and wellbeing for the people of Ireland, together to manage their own health conditions.
with the HSE’s Healthy Ireland in the Health
Services – National Implementation Plan 2015 – This plan builds on the strengths and
2017 and the Department of Health’s Sláintecare achievements of staff across all service areas
Implementation Strategy. in Community Healthcare East. I would like to
express my gratitude to all those who contributed
Our healthcare system faces many challenges that to the development of this plan, attended our
include improved life expectancy, more people living Healthy Ireland consultation workshops, provided
with one or more long-term conditions, increasing submissions or assisted in any manner.
population diversity and health inequalities. We
adopted a life course approach in developing our I would like to also convey my thanks to a number
Healthy Ireland Plan, as it recognises the factors of persons for their support and direction with the
which influence health outcomes across the life development of this plan to include:
span, from preconception to older age. Therefore,
actions set out in this plan are aimed at promoting Members of the National Health and Wellbeing
wellbeing at the various stages of a person’s life. team Dr. Stephanie O’Keeffe, Ms. Sarah Mc
Cormack, the National Priority Programme
It is vital for us to continue to strengthen Leads and Public Health
interagency collaborations with our health Ms. Martina Queally Chief Officer, the CHO 6
sector partners, our external partners, and our Senior Management Team, Members of our
community in its entirety; to think differently to Healthy Ireland Steering Group and members of
improve relationships; to adapt new improved the sub-group for taking ownership of this plan
ways of working ultimately with a common Finally to my own team member Ms. Idowu
goal to improve wellbeing and to build resilient Akingbagbohun and to members of the Health
communities now and for the future; and to aim Promotion and Improvement team Dr. Michelle
to control the spiralling costs of health care. Hardie-Murphy and Ms. Imelda Halton for their
commitment and support in bringing this plan
Members of our population are key enablers to to its final conclusion
achieving improved health and wellbeing for our
communities, whether for others, or indeed taking I look forward to working with all staff and
measures themselves to abate the prevalence of external partners in Community Healthcare East
chronic conditions, in order to remain healthy and to implement this plan over the coming years.
to age well. The actions in this plan allow key
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Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
Abbreviations and Acronyms
AA Alcoholics Anonymous
CA Cocaine Anonymous
CHO Community Healthcare Organisation
CHN Community Healthcare Network
COPD Chronic Obstructive Pulmonary Disease
CSO Central Statistics Office
CYPSC Children and Young People’s Services Committee
DML Dublin Mid-Leinster
ECRDATF East Coast Region Drugs and Alcohol Taskforce
H&WB Health and Wellbeing
HoS Head(s) of Service
HPV Human Papillomavirus
HR Human Resources
HSE Health Service Executive
IEHG Ireland East Hospital Group
LCDC Local Community Development Committee
LGBTI Lesbian, Gay, Bisexual, Transgender, and Intersex
MEN C Meningococcal C
MH Mental Health
MMR Measles, Mumps and Rubella
MUST Malnutrition Universal Screening Tool
NA Narcotics Anonymous
PC Primary Care
PHEW Programme for Healthy Eating and Weight Management
PREPARED Primary Care Education, Pathways and Research in Dementia (dementia training)
QPS Quality and Patient Safety
SC Social Care
SMS Self-Management Support
SMT Senior Management Team
SRF Service Reform Fund
WHO World Health Organization
WTE Whole Time Equivalent
YODA Youth Drug and Alcohol Service
7 7
Community Healthcare East Healthy Ireland Plan 2018 - 2023 8
Community Healthcare East Healthy Ireland Plan 2018 - 2023
Section 1
Introduction to Healthy Ireland
9Community Healthcare East Healthy Ireland Plan 2018 - 2023
Introduction to Healthy Ireland
Healthy Ireland – A Framework for Improved Healthy Ireland recognises that health inequalities
Health and Wellbeing 2013-2025 (1) is a are underpinned by the conditions in which people
government framework to improve the health are born, grow, live, work, and age. These broad
and wellbeing of people living in Ireland. It was social and economic circumstances that influence
developed in response to rising levels of chronic health throughout the life course are referred to
conditions, lifestyle trends that threaten health, as the “social determinants of health”, as depicted
and persistent health inequalities. in Figure 1.1, which is an adaptation of Dahlgren
and Whitehead, 1991.(2)
Healthy Ireland sets out a vision where everyone
can enjoy physical and mental health and
wellbeing to their full potential, where wellbeing
is valued and supported at every level of society,
and where it is everyone’s responsibility.
The framework has four key goals:
Increase the proportion
Goal 1 of people who are healthy
at all stages of life
Figure 1.1: Social determinants of health
(Adapted from Dahlgren and Whitehead, 1991)
Goal 2 Reduce health inequalities
At an international level, the concept of addressing
social determinants throughout the life course
is strongly supported by the World Health
Organization (WHO).
Protect the public from
Successful improvement of health at key life
Goal 3 threats to health and
stages requires a continuum of interventions
wellbeing
across the life-course, combined with efforts to
strengthen health delivery systems and address
the broader social and economic determinants
Create an environment of health.
where every individual (Zsuzsanna Jakab, WHO Director for Europe)
Goal 4 and sector of society can
play their part in achieving The development of this Community
a healthy Ireland Healthcare East Healthy Ireland Plan (2018-
2023) is underpinned by an awareness of the
importance of the social determinants of health
in the implementation of Healthy Ireland in this
geographical area.
In light of the above, this plan recognises that
there are serious health challenges that occur
at all stages in life, which cannot be tackled in
isolation. Examples include:
10Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
49% of Irish people aged over 50 Lasting solutions to health problems can only be
years have at least one chronic tackled by a “joined-up” approach, partnerships
disease between different sectors of society, and the
direct involvement of the population.
One in ten aged over 50 years have
diabetes
In pursuit of this joined-up approach, a number
Chronic of strong partnerships have been developed
There are 36,000 new cases of
Disease cancer diagnosed each year in in Community Healthcare East, in an effort to
Ireland address the broader determinants of health
and to ensure an intersectoral approach to
There has been a rapid ageing implementation and sustainability.
population resulting in increased
multi-morbidity and care support
Implementing Healthy Ireland in the Health
needs
Services
The Healthy Ireland in the Health Services:
18.5% of the Irish population was
National Implementation Plan 2015-2017 (3) sets
Mental recorded as having a mental health
out governance structures and identifies three
Health disorder, such as anxiety, bipolar,
strategic sector-wide priorities (Figure 1.2).
schizophrenia, depression in 2016
Almost one in five of the population
currently smoke
75% of people in Ireland have
Lifestyle consumed alcohol in the past
Choices 12 months
9% drink sugar-sweetened drinks Figure 1.2: HSE’s three priority areas for
on a daily basis, and 33% drink Healthy Ireland
them at least once a week
This Healthy Ireland Plan for Community
Healthcare East has been developed in the
The breastfeeding initiation rate in context of this national plan for the population of
Ireland is currently among the Dublin South East, Dún Laoghaire and Wicklow.
lowest in the world, with only 60%
Early of babies recorded as having any
Childhood breastfeeding in 2016
One in five Irish children are
overweight
11 11Community Healthcare East Healthy Ireland Plan 2018 - 2023 12
Community Healthcare East Healthy Ireland Plan 2018 - 2023
Section 2
Overview of Community Healthcare East
13Community Healthcare East Healthy Ireland Plan 2018 - 2023
2.1 Geography of Community Healthcare East
In 2015, the HSE established nine Community Geographically, it extends along the Eastern
Healthcare Organisations (CHOs) (Figure 2.1) coastline from Dublin to Wicklow. Two
to manage and deliver the full range of health major motorways (M11 and M50) serve the
services in communities; to enable and support geographical area. While the urban area is well
integrated care across community services served by national and commuter rail services,
and between the community and hospital the DART, the Luas line, and bus routes, some
services; and to establish integration with wider rural areas in Wicklow are accessible only by
public service organisations, local authorities, designated bus routes and can be isolated.
and voluntary organisations. (4) Community
Healthcare East, formally known as CHO 6, is Community Healthcare East has many natural
one of the nine CHOs. amenities, including beaches, parks and the
Dublin and Wicklow Mountains.
CHO 1
CHO 2
CHO 8 CHO 9
CHO 7
CHO 6
CHO 3
CHO 5
CHO 4
Figure 2.1: Map of Community Healthcare Organisations, highlighting Community Healthcare East (CHO 6)
14Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
2.2 Population Profile
The profile of the population and the projected
population changes are key factors in planning for
future health needs and service configurations.
Figures in this section are based on the Central
Statistics Office (CSO) census results 2016,
(5)
unless otherwise referenced. The projected
population figures are provided by the Department
of Health’s Health in Ireland: Key Trends 2017.(6)
Community Healthcare East has a population
of 393,239, which represents 8.3% of the total
population of the country (Figure 2.2).(5) This
reflects an increase of 5.1% since the 2011
Figure 2.2: Community Healthcare East (CHO
census. The average population increase
6) population as a percentage of the national
nationally was 3.8% during the same period,
population
illustrating that the population in this area is
growing at a faster rate than the national average.
Age ranges
Figure 2.3 illustrates the breakdown of the
population of the area by age and sex.(5) The
breakdown when compared with census reports
from previous years indicates that the population
of Community Healthcare East is ageing.
Figure 2.3: Community Healthcare East population breakdown by age and sex
15 15Community Healthcare East Healthy Ireland Plan 2018 - 2023
The number of people aged over 65 years increased Birth Rate
by 8,736 between 2011 and 2016, representing
A general reduction in birth rate is recorded in
an increase of 14.8%. The rate of increase in
Community Healthcare East between 2017 and
people aged over 75 years is also higher than the
2018 (Table 2.3). Of note, a significant reduction
national average rate, as illustrated in Table 2.1.
in births (13.6%) is evident in Wicklow (data
from the Child Health Department, Community
Table 2.1: The percentage population change
Healthcare East).
nationally and in Community Healthcare East in
adults aged over 75 years Table 2.3: Births in Community Healthcare East
in 2017 and 2018
Percentage Population Change
Age (2011 – 2016)
Group Births in Community Healthcare East
National CHO 6
75-79 years +13.2 +15.7 Catchment 2017 2018 Change Change
Area (n) (%)
80-84 years +15.6 +17.8 Dublin
South East 1,689 1,648 -41 -2.5%
85+ years +15.6 +22.5
Dún Laoghaire 1,582 1,541 -41 -2.7%
Wicklow 1,647 1,450 -197 -13.6%
Another significant figure in relation to the age
profile is the reduction of young adults in the 20-
35 year age range (Table 2.2). It is anticipated Projected Population
that the decline in this cohort will impact on the
As cited earlier, the overall trend in population
birth rate over the coming years, as two-thirds of
growth is expected to continue. Irrespective
babies nationally are born to mothers aged 30-39
of the declining birth rate, the population is
years. (7) Already, the number of 0-4 year olds has
estimated to increase by 7.6% locally, versus 4%
reduced from 25,478 in 2011 to 25,102 in 2016
nationally, by 2022.(6) An increase of 5% (1.4%
(a reduction of 1.3%). Children aged 0-9 years
nationally) is projected for 0-17 year olds; 5.4%
accounted for 13% of the population in 2016.
(2.7% nationally) for 18-64 year olds; and 28.8%
(21% nationally) for those aged over 65 years.
Table 2.2: The percentage population change
nationally and in Community Healthcare East in People with Disabilities
20-35 year olds
According to the CSO, 12.8% (50,199) of
the Community Healthcare East population
Percentage Population Change self-reported having some form of disability,
Age (2011 – 2016)
Group compared with a national average of 13.5%.
National CHO 6
According to the national databases of disabilities
20-24 years -7.9 -2.6 in Ireland, 1,473 people are registered as having
25-29 years -17.6 -13.3 an intellectual disability (8) and 1,166 people
are registered as having a physical or sensory
30-35 years -8.1 - 4.3
disability in this area in 2017. (9) As the census
data are self-reported, the results capture all
forms of disability at all levels of need. All these
records are taken into account when planning
and delivering health and social care services for
the area.
16Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
Nationality
The diversity of the population in Community
Healthcare East requires health services to be
provided in culturally appropriate ways that
take into account the increasing diversity within
the area, to include language, faith beliefs, and
culture. See Figure 2.4 for the breakdown of the
population by nationality.
Extremely Affluent
Very Affluent
Affluent
Marginally
above average
Marginally
below average
Disadvantaged
Very disadvantaged
Irish 85.3%
Extremely
UK 2.1% disadvantaged
Polish 1.5%
Lithuanian 0.3%
Elsewhere in EU 3.4% Figure 2.5: Pobal HP Deprivation Index of
Elsewhere in world 3.7% Community Healthcare East by small area
Visitors/Not stated 3.5% (Census 2016)
Figure 2.4: Community Healthcare East
population profile by nationality (Census 2016) Traveller population
According to Census 2016, Irish Travellers
account for 0.3% of the population (1,167) of
Deprivation Level Community Healthcare East. Findings from the
All Ireland Traveller Health Study (2010) (12)
Higher levels of deprivation are consistently
highlight health inequities, in this population
linked, in studies and reports, to poor health
group, in terms of life expectancy and infant
outcomes.(10; 11) According to Census 2016,
mortality. At the time of publication (2010),
42,586 people (10.8%) across the area are
Traveller men were expected to live to 61.7
recognised as being disadvantaged, very
years (15.1 years less than men in the general
disadvantaged, or extremely disadvantaged.
population) and Traveller women had a life
Figure 2.5 illustrates deprivation levels in
expectancy of 70.1 years (11.5 years less than
Community Healthcare East by small area (Pobal
women in the general population).
HP Deprivation Index).
17 Members of the Wicklow Traveller Health Group 17Community Healthcare East Healthy Ireland Plan 2018 - 2023
For Travellers, the infant mortality rate was Furthermore a mortality study of 201 homeless
14.1 per 1,000 live births, compared with 3.9 deaths (between 2011 and 2015) in Dublin shows
per 1,000 live births in the general population. that the median age at death was 44 years for
In men, suicide rates were nearly seven times men and 36 years for women.(15) This indicates
higher among Travellers than in the general a much lower age than the general population
population. life expectancy of 79.9 years for males and 83.6
years for females, (6) as shown in Figure 2.7.
As the number of Travellers residing in
Community Healthcare East is relatively low, The findings emphasise the significant impact
there is a critical need to prevent further of homelessness on health and the poor health
marginalisation by providing targeted, culturally- outcomes for the homeless population. Research
appropriate supports. Working in partnership has shown that while Travellers represent less
with Traveller organisations in the area (and than 1% of the Irish population, they account for
through the Eastern Regional Traveller Health 9% of the homeless population. (16) Therefore, the
Unit) to address many of the challenges faced consequences of homelessness on the Traveller
by Travellers is integral to meeting their health population, whose members already experience
needs. poor health outcomes, is significant.
Homelessness
There were 9,987 people homeless in Ireland
in the week of 21-27 January 2019.(13) This
figure includes adults and children accessing
emergency accommodation. The number of
families accessing emergency accommodation
have also increased, rising from 884 in January
2016 (week of 25-31 January) to 1,614 in January
2019 (week of 21-27 January), representing an
83% increase.(13)
A review of hospital data in Ireland from 2005-
2014 found that there has been a 406% increase
in emergency admissions of individuals with “no
fixed abode”. The study reports that the majority Median Mortality Age (mortality study of a
of the homeless patients admitted (57.3%) had a cohort of homeless people in Dublin)
mental/behavioural disorder of which 34.2% was Population Life Expectancy
due to alcohol misuse and 21% due to substance
misuse (14) (Figure 2.6). Figure 2.7: Median age of mortality among
homeless people by sex compared with population
life expectancy.
Figure 2.6: Mental/behavioural disorder diagnosis
of emergency in-patient admission in those with “no
fixed abode” 2005-2014
18Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
2.3 Population Health and Wellbeing
As stated earlier, the population’s health and Chronic Disease
wellbeing is influenced by the broader social
According to WHO’s Non Communicable Disease
determinants of health (Figure 1.1), which
Country Profile 2018, (21) non-communicable
influence and impact on each person’s wellbeing,
diseases pose the greatest risk to health in
health and lifestyle choices.
Ireland and are estimated to account for 91%
of all deaths. According to the HSE’s 2014
Self-reported Ill Health
Report from the Prevention of Chronic Disease
In Community Healthcare East, 5,214 people Programme, cancer, cardiovascular disease,
(1.3%) rate their health as bad or very bad, an Chronic Obstructive Pulmonary Disease (COPD)
increase of 7.9% (381 people) between 2011 and diabetes account for 60% of all deaths
and 2016. Nationally, 1.6% report their health worldwide and 76% of deaths in Ireland. (22)
(17)
as bad or very bad.
The highest prevalence of these conditions is in
Health Protection the population aged 50 years and over. As the
Immunisation is vital to prevent diseases and age of the population increases, the number of
protect life. According to the WHO, immunisation people living with one or more types of chronic
is estimated to avert between 2 and 3 million disease will increase proportionally. The number
deaths globally each year and is recognised as one of people in this age cohort living with one or
of the most cost-effective health investments. (18) more chronic disease is estimated to increase by
40% within the next decade. (23)
Community Healthcare East childhood
immunisation uptake rates are below the
recommended WHO and national target rate of
95%. This target rate is needed to effectively
stop the spread of infectious diseases. Table 2.4
illustrates the uptake of immunisation in the
area based on the National Healthcare Quality
Reporting System Annual Report 2018.(19)
Table 2.4 Immunisation uptake rate nationally
and in Community Healthcare East
*MMR **Men C ***HPV
% % %
Community
Healthcare 91 87 61
East
National 92 87 51
* 1 dose of MMR by 24 months of age (2017 data)
** Men C by 24 months of age (2017 data)
*** HPV uptake amongst girls in 1st year of
second level schools and their age equivalents
(20)
for academic year 2016/2017
19 19Community Healthcare East Healthy Ireland Plan 2018 - 2023
Health Behaviours
Healthy Ireland surveys (24; 25; 26) show a slight Findings of the surveys provide a national
improvement in some aspects of healthy living, overview of health behaviours in people over
but it is also evident that there is still much 15 years of age, some of which are outlined in
work to be done in improving health behaviours Figure 2.8. (24; 25; 26)
among the population.
Figure 2.8: Summary results from the Healthy Ireland Surveys 2016, 2017 and 2018
20Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
Responding to Key Challenges to Achieve
Improved Population Health and Wellbeing
Health Inequalities
The projected increase in life expectancy is the needs of the older populations that we serve.
unlikely to benefit all social groups equally, This includes preventing chronic disease and
unless existing health inequalities are addressed. supporting chronic disease management.
It is crucial to identify vulnerable, marginalised
and disadvantaged groups requiring additional There is also a specific challenge in terms of
support and specific targeted programmes that dementia. The estimated number of people living
are designed to reduce inequalities and address with dementia in Community Healthcare East
their specific healthcare needs. Community is 4,961, 10% of whom are aged less than 65
Healthcare East is committed to tackling health years. (27)
inequalities and will continue to work with
partners to adapt approaches to meet the needs Meeting the needs of the older population
of the population. requires collaborative inter-agency working and
communication. Community Healthcare East is
Adopting Positive Health Behaviours proud to be an active participant in the area’s
In order to tackle chronic disease, interventions Age Friendly City/County Alliance – a strategic
will be tailored to support those most in need. partnership that brings together the statutory,
Specific actions outlined in this plan (Section 5) private, voluntary and community sectors
aim to promote positive health behaviours and to create new initiatives and services and to
address common risk factors. enhance those that already exist for older people
in the area. The key element of the alliance is
Community Healthcare East continues to support the cross-sectoral cooperation in finding ways
the implementation of the national screening to improve the lives of older people in their
programmes through education and promotion. communities, in terms of their health, housing,
These include Breast Check, Cervical Check, social and personal wellbeing.
Bowel Screen and Diabetic Retina Screening.
Work will continue to improve the uptake of these Increased research and knowledge is always
screening services, especially within marginalised required and encouraged to promote positive
groups. health, wellbeing and to improve the quality of
life for older people in the community. Efforts will
The HSE’s immunisation programmes provide also be intensified to highlight the importance of
protection from a variety of infectious diseases maintaining a healthy lifestyle from an early age,
from an early age and across the lifespan. Health to support positive ageing.
and social care professionals continually work to
improve the uptake rates of such programmes.
Ageing Population
The ageing of the population represents one
of the most significant demographic and social
developments encountered by Irish society. While
it poses challenges, it also brings opportunities
to promote age-friendly strategies that
enhance positive ageing; develop age friendly
environments; and align our health systems to
21 21Community Healthcare East Healthy Ireland Plan 2018 - 2023
2.4 Governance and Leadership
The HSE’s Community Healthcare Organisations Operations. The Chief Officer is supported by
– Report and Recommendations of the Heads of Service (HoS) and Heads of Function.
Integrated Service Area Review Group (4) outlines
the governance arrangements within the nine The delivery of the actions identified in this plan
community healthcare organisations. Community will be the shared responsibility of the HoS and
Healthcare East is led by a Chief Officer, who Heads of Function and will be driven by the HoS,
reports to the National Director of Community Health and Wellbeing.
Governance Structure Community Healthcare East
Figure 2.9: Community Healthcare East governance structure
22Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
2.5 Community Healthcare Networks
The Community Healthcare Organisations Report The CHNs provide a mechanism for integrating
(4)
and the Sláintecare Action Plan (28) identify services at a local level to address the health and
community healthcare networks (CHNs) as the social care needs of the population.
potential basis of population health planning
and delivery structure within the community A range of services are provided by Primary
healthcare organisation, to integrate and deliver Care, Social Care, Mental Health and Health and
services to local populations. Health services are Wellbeing functions within each CHN. Further
provided across eight CHNs in the area, with details of the workforce and services in the area
populations of the CHNs ranging from 30,183 to are available in Section 2.6.
66,561 (Figure 2.10). The catchment areas are
reflected in Table 2.5 These CHNs facilitate the delivery of integrated
care by multidisciplinary teams to achieve
Table 2.5: improved care pathways for the population.
Location and population of Community Healthcare
Networks in Community Healthcare East By continuing to work in collaboration with
community partners and statutory agencies
such as local authorities, Tusla - child and family
Baggot Street, Donnybrook, agency, and Section 38 and Section 39 agencies,
CHN 1 Ranelagh, Sandymount, Ringsend initiatives and programmes are provided that
Population: 51,830 will:
Balally, Ballinteer, Churchtown, a) support people to remain healthy and enjoy
CHN 2 Dundrum/Milltown physical and mental health and wellbeing to their
Population: 45,939 full potential
Blackrock, Stillorgan, Booterstown, b) create community supports for people with an
CHN 3 Monkstown established disease to self-manage their illness
Population: 49,843 where appropriate and feasible, and
Dalkey, Dún Laoghaire, Killiney, c) deliver supports in response to the needs of
CHN 4 Loughlinstown the population
Population: 56,048
Within Community Healthcare East, acute and
Cabinteely, Foxrock, Shankill, specialist care is provided by hospitals in the
CHN 5 Carrickmines HSE Ireland East Hospital Group (IEHG). These
Population: 30,183 include:
St Vincent’s University Hospital
Leopardstown, Sandyford, St Michael’s Hospital
CHN 6 Ballinteer, Stepaside, Kilternan St Columcille’s Hospital
Population: 36,005 The Royal Victoria Eye and Ear Hospital
The National Maternity Hospital, Holles Street
Bray, Greystones,
CHN 7 Newtownmountkennedy The Children’s Hospital Group (consisting of Our
Population: 66,561 Lady’s Children’s Hospital Crumlin, Temple Street
Children’s University Hospital, and the National
Arklow Rathdrum, South Wicklow, Children’s Hospital at Tallaght-located on the
CHN 8 Wicklow grounds of Tallaght University Hospital) provide
Population: 56,830 acute and specialist care to children across the
country. All national paediatric specialities are
in the group and children are referred to these
services based on their healthcare needs.
23 23Community Healthcare East Healthy Ireland Plan 2018 - 2023
Sláintecare
The alignment of hospital groups and CHNs is a The recently published Sláintecare Action Plan
fundamental feature of Sláintecare. (29) Increased 2019 (28) provides the roadmap to achieving
integration between the hospital sector and improved care for the population. It recognises
community-based care will enable the delivery the importance of keeping the population well
of person-centred care closer to home. The and healthy in the community. It is committed to
Sláintecare Implementation Strategy (30) provides redesigning services based on population need
a vision for healthcare in Ireland, where patients and size, with the introduction of appropriate
are paramount. There is a strong emphasis on supports for new services to be delivered within
prevention and public health, and for care to the community, rather than in the acute setting.
be provided at the most appropriate service
level. CHNs are central to the health service
coordination and provision to achieve this vision.
Figure 2.10: Community Healthcare Networks in Community Healthcare East
24Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
2.6 Workforce and Services
Workforce
The December 2018 Employment Report (31) The staff breakdown includes a number of
shows that there are 4,405 employees between regional services which are administered by the
Community Healthcare East and Section 38 area. These services are further described under
agencies, giving a total of 3,808 whole-time Primary Care Services.
equivalents (WTEs). There are 1,636 WTEs
employed directly by the HSE and 2,172 WTEs A dedicated workforce is Community Healthcare
employed by Section 38 agencies. The staff East’s greatest asset and actions to support staff
breakdown by gender is 78.9% female and 21.1% health and wellbeing are included in this plan.
male. The largest staffing categories are: Nursing
(26.9%), Patient and Client Care (24.5%), and Health and Wellbeing
Health and Social Care Professionals (22.8%). A
Health and Wellbeing leads on initiatives to
further staff breakdown by discipline is shown in
improve the general health and wellbeing of
Table 2.6.
the population, including physical, mental and
social health. It emphasises the prevention of
Table 2.6: Community Healthcare East (CHO 6)
illness, self-management and addressing health
and Section 38 staff breakdown (December 2018)
inequalities.
This function oversees the delivery of key national
policies and initiatives such as the Healthy Ireland
in the Health Services Implementation Plan, (3) flu
protection, living well with a chronic condition,
and health promotion, including school education
programmes.
This is achieved by working closely with
Community Healthcare East services and having
inter-agency collaborations.
25 Clonskeagh staff on a lunchtime walk 25Community Healthcare East Healthy Ireland Plan 2018 - 2023
Primary Care Social Care - Disability
Primary Care looks after the day-to-day healthcare A wide range of disability services are provided
needs of the population and is often the first point to those with physical, sensory and intellectual
of contact with the health service. The Primary care disabilities, and autism. Disability services are
team includes General Practitioner, Community aligned to national policy documents such as the
Nursing, Physiotherapy, Occupational Therapy, HSE’s Time to Move on from Congregated Settings:
Speech and Language Therapy, Psychology and A Strategy for Community Inclusion (32) and The
Dental Services. These teams provide care to Interim Standards for New Directions: Services
individuals in their own home or an appropriate and Supports for Adults with Disabilities. (33)
setting as close to home as possible. Primary Care
is closely aligned to the Ireland East and Children’s A range of services are provided in day centres
Hospital Groups in the delivery of care. Service to facilitate learning, social development and
users are referred to these hospital settings when inclusion. Family involvement is crucial in the
their health needs are sufficiently complex and planning and delivery of services. Families are
cannot be met by community services. also supported to care for their loved ones in their
homes, through home assistance with access to
A number of national and regional services are respite care.
also managed by Primary Care in Community
Healthcare East. These include: The Public Health Over 80% of disability services are provided in
Laboratory, The Public Analyst Laboratory, The partnership with Section 38 agencies (National
Primary Care GP Unit, The Regional Orthodontic Rehabilitation Hospital, Sunbeam House Services,
Services, The Eastern Region Civil Registration Children’s Sunshine Home, St. John of God
Service, Anti-Human Trafficking, Women’s Health Carmona Services) and Section 39 agencies.
Service, and the Gay Men’s Health Service. Contractual arrangements are in place to ensure
that these agencies deliver specific services to
The focus of these services is on improving the meet client needs.
health and wellbeing of the population through
early diagnosis, treatment and management of The approach taken in the planning, development
illness, enabling people to live in their own homes and delivery of disability services focuses on
for as long as possible and to achieve optimum enabling people with disabilities to achieve their
quality of life within their community. full potential, living in the community, and as
independently as possible.
The future vision for the delivery of Primary Care
services is through distinct networks, to achieve
greater integration of care for the population
served.
Primary care Dental team providing
26
26 oral health informationCommunity Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
Social Care – Older Persons
Community Healthcare East’s Older People The guiding principles are dignity and respect;
Services are committed to ensuring that the the right to decide; being listened to and
health, welfare, rehabilitation, social and heard; having adequate, timely and appropriate
personal care needs of older people are planned, information; the services being person-centred
managed and delivered to the optimum of and accessible; the independence and autonomy
available resources within this area. This involves of each older person being promoted; and
working with older people, their families, carers, the right for each older person to live in their
and voluntary, statutory and private services. own home safely for as long as possible. The
preferences, beliefs and values of older people
The focus of the services is always on the individual are also promoted and respected.
older person. Access to health and social care
services are based on clinical assessment and Ageing is a normal physiological process and
provided in the most appropriate place for the not a disease. While ageing is inevitable and
older person. Home support, day care, respite irreversible, the chronic disabling conditions
and extended care are provided, when required, that sometimes accompany it can be prevented
with the consent of the person. These services and delayed. This can be achieved not only by
are flexible, coordinated, accessible, equitable, providing medical intervention, but – often more
responsive and appropriate to the individual effectively – by influencing social, economic
need – the right service in the right place at and environmental conditions and lifestyle
the right time. The Older People Services work behaviours.
closely with older people themselves, statutory
bodies, voluntary organisations, faith groups
and community groups, to promote active
participation of older people in their communities
as a means to enhance their health and wellbeing.
27 27Community Healthcare East Healthy Ireland Plan 2018 - 2023
Mental Health
Mental health is an integral and essential residences in the community supported by
component of health throughout the life course. community-based mental health teams, with
The WHO constitution states: “Health is a state access to care in an acute inpatient facility, when
of complete physical, mental and social well- deemed necessary.
being and not merely the absence of disease or
infirmity.” With a balanced mental disposition,
While specialist mental health services are
people are more effective at coping with the
delivered to children and adolescents (up to,
stresses of life, can work productively, and are
and including, the age of 17) by the Child and
better able to make a positive contribution to
Adolescent Mental Health Services, General
their communities. The determinants of mental
Mental Health Services are provided to those
health are strongly linked to the broader social
aged 18 years to 64 years, and Psychiatry of
determinants of health.
Later Life Services are available to those over
65 years (not already being catered for by the
In light of the above, mental health services in
General Mental Health Services). Services are
Community Healthcare East are being developed
also commissioned through a Section 38 Service
in accordance with A Vision for Change, (34)
Arrangement with St. John of God Community
which sets out a framework for building and
Mental Health Services.
fostering positive mental health across the
entire community and for providing accessible,
Strengthening relationships with statutory
community-based, specialist services for people
agencies, community groups, sports and
with mental illness.
voluntary groups is crucial in promoting and
developing resilience among the population,
Mental health services in the area are delivered
resulting in reduced demand for mental health
within the community setting in service users’
services.
homes, day hospitals, outpatient clinics, or
28Community Healthcare East Healthy Ireland Plan 2018 - 2023
Section 3
Developing the Community Healthcare East
Healthy Ireland Plan
29Community Healthcare East Healthy Ireland Plan 2018 - 2023
3.1 Developing the Healthy Ireland Plan
This plan has been developed to support the and wellbeing of the population of Community
improvement of health and wellbeing for the Healthcare East are highlighted overleaf and in
population of Community Healthcare East. Section 5.
It is aligned with national strategic frameworks In the delivery of this Healthy Ireland Plan,
and plans (Appendix 1), in particular, the Healthy trends in births, prevalence of chronic illnesses,
Ireland Framework, (1) the Healthy Ireland in the migration to the area, and changes in ethnic mix
Health Services National Implementation Plan (3) and cultures (both in terms of workforce and
and the Sláintecare Implementation Strategy. service users) will continue to be monitored, to
(30)
A number of employee workshops were held inform service planning and delivery. Building
across all levels of the organisation, to obtain connections is crucial between the health
valuable input from staff (details in Appendix services, schools, families and communities and
3). This informed the development of this plan is an essential component of supporting positive
and identified a number of ongoing initiatives health and wellbeing across the life course.
in the area. Some initiatives promoting health
30Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
Initiatives promoting Health and Wellbeing in
Community Healthcare East
Paediatric Motor Skills Class Ups and Downs of Postnatal Pilates for
for Mums and Children Motherhood Class Mums and Babies
A multidisciplinary programme, Physiotherapist led Pilates class
including nursing, physiotherapy aimed at engaging mothers in
and psychology input. The 12- a baby friendly environment.
week class addresses the mental The classes foster peer support
and physical health needs of and social engagement with no
mothers, post-delivery, in a peer- child-minder costs.
supported environment, and
guides them in making healthy
lifestyle choices. Schools Programme
Physiotherapy led classes aimed
at working with mothers in a
SPECS – Supporting Parents
peer-supported environment
and Early Childhood Services
to guide them in assisting their
babies and children to achieve A programme that provides
all developmental markers, a speech and language intervention
healthy BMI and fitness levels. directly to community crèches
and preschools, using a
Infant Mental Health solution-focused approach to
Awareness Training for Staff empower parents. It is targeted
at marginalised groups and
Education sessions to encourage delivered with strategic partners. Health Promotion and
and guide staff to engage parents Improvement Officers support
in discussions on infant mental schools and centres of education
health, during routine visits. Staff ENGAGE in implementing the Department
are informed of the importance and of Education and Skills’
techniques of such engagements Engage workshops are of Wellbeing Policy Statement
and the inter-relationship interest to a broad range and Framework for Practice.(35)
between infant mental health and of service providers and In doing so, they play a role in
communication. practitioners (all genders and ensuring that young people’s
sectors) who wish to connect experience of education is one
in a more meaningful way with where wellbeing is valued and
Screen Time Advise men and boys on health and nurtured, and where skills are
wellbeing related matters. The acquired to help them deal with
workshop also gives time to challenges to their wellbeing.
consider the practicalities of
“what works” when engaging
with men and boys on their Women’s Pelvic Health
health issues. and Continence
Management Class
Mini Heart Health Check A one-to-one session for
An initiative of Speech and
women of all ages to address
Language Therapy, the
Free mini heart health checks pelvic girdle pain, instability and
programme uses general
were provided to staff in urinary and faecal incontinence.
consultation time with parents
collaboration with the Irish The programme has produced
to discuss the importance of
Heart Foundation. The initiative excellent feedback and has
reduced screen time for children
supported staff to reflect on resulted in many avoided
and to promote physical
their own health and wellbeing. surgical procedures.
activities.
31 31Community Healthcare East Healthy Ireland Plan 2018 - 2023
Foot Protection Service Flu Vaccination Patient Experience Survey
Delivered by the Podiatry
Services, the initiative is
aimed at supporting those at
risk of developing foot ulcers.
Individuals within the area
who are deemed by medical
practitioners to be at risk of
developing foot ulcers are
referred to and catered for by Community Healthcare East
A nurse-led initiative to
this service. seeks constant feedback from
encourage a better uptake
service users at point of care
of the flu vaccination among
and through designed surveys
healthcare workers and
to guide service planning and
Kick Start to Recovery residents at HSE long- term
delivery. The area’s services
care facilities. It encompasses
are rated as highly satisfactory
peer vaccination training and
by its users, who provide
on-site flu vaccination clinics.
excellent feedback. Innovative
suggestions are taken into
account for improving existing
Parkinson’s services and developing new
Self-Management Class initiatives.
PHEW
An initiative delivered by the
Mental Health Care Teams in
collaboration with the Football
Association of Ireland. The
programme uses football as
a therapy to enhance social
An eight-week multidisciplinary
participation.
programme for individuals
with Parkinson’s disease. This
programme is designed to allow
Family and Carer long-term peer support through Programme for Healthy Eating
Support Groups links with existing services in and Weight Management
the local community. (PHEW). Classes are led by
Across Community Healthcare dieticians with multidisciplinary
East there are various groups input. The programme provides
providing specialist support to Pet Therapy information on healthy weight
family members and carers of management and supports
those receiving Mental Health individuals in setting personal
Services. achievable goals.
Better Bones Class Falls Prevention and
Management in Elderly
Setting
An evidence-based, physiotherapy Pet Therapy is an integral part
-led eight to ten week group of St. Colman’s residential care A specially designed programme
exercise programme designed for centre. Goats, ducks and hens delivered by day and residential
and targeted at the frail elderly, are accessible on site, with care services. The programme
to address osteoporosis and picnic tables provided, where includes falls prevention
sarcopenia. residents and their families treatment and advice in order
can view and interact with the to reduce fractures and hospital
animals. admissions as a result of falls.
32Community Healthcare East Healthy Ireland Plan 2018 - 2023 Community Healthcare East Healthy Ireland Plan 2018 - 2023
3.2 Adopting a Life Course Approach
The life course approach considers how health Policy and Political Triggers
and disease develop across the lifespan. It
The Healthy Ireland Framework (1), Healthy
focuses on a healthy start to life, targets the
Ireland in the Health Services (3) and the
needs of people at critical periods throughout
Sláintecare Report (29) provide the policy context
their life, and acknowledges that complex issues
for this plan. They aim to increase the proportion
experienced by the disadvantaged in society can
of people who are healthy at all stages of life. To
be passed from generation to generation. By
support current and future health and wellbeing,
understanding the influences of risk factors and
health risk factors need to be addressed and
protective factors, the development of health over
protective factors need to be promoted at every
time, and the multiple determinants of health
stage of life across the life course. Sláintecare
outcomes, the life course approach recognises
focuses on redesigning health care around the
the opportunity to promote health at key stages
needs of people to improve population health
of life from preconception through pregnancy,
and wellbeing.
infancy, childhood, adolescence and adulthood
to old age. Aspects covered in the life course
Data and Science Triggers
approach include physical activity, nutrition, early
childhood development, supporting parenthood, Section 2 of this document outlines the population
vaccinations, increasing health knowledge, long- and the challenges for Community Healthcare
term care, and integrated care. East in achieving population health and
wellbeing. In particular, the projected increase
The WHO Europe published a document in 2017 in life expectancy and the health inequalities in
entitled How small Countries are Improving Health the area provide the basis for selecting the life
Using the Life-course approach, (36) which identifies course approach that considers complex social
two key triggers for taking action using the life and economic determinants of health and health
course approach: policy and political triggers, behaviours. Facilitating factors for adopting the
and data and science triggers. These same two life course approach – as identified in the WHO
triggers provide the rationale for adopting the document – exist in this area. These include
life course approach in identifying actions for the a network of services that are responsive to
Community Healthcare East Healthy Ireland Plan, population needs, and existing partnerships
depicted by icons in Figure 3.1. and established relationships with external
organisations to support the approach.
Life Course Icons
Pregnancy Baby Child Adult Adult 50 +
Figure 3.1: Life-Course Icons
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