Appendices

Appendix 1 The consultation process for the Health Strategy
Appendix 2 Recent Strategies and Policy Documents
Appendix 3 Statutory bodies and non-statutory organisations
Glossary of terms
References

Appendix 1

The consultation process for the Health Strategy

Background

The Minister for Health and Children decided to consult widely in preparing the Health Strategy. Colgan and Associates were appointed as consultants in February, 2001 to design, plan, implement and report on the consultation programme.

The main objective of the consultation process was to gather the views of members of the public, service users, service providers, staff and management of the health services and to channel these views into the development of the Health Strategy.

A separate report providing full details of the consultation process and its findings, Your Views about Health, is available from the Department of Health and Children.

Structures for preparing the new Strategy

A number of structures were set up to prepare the new Strategy. The preparation was overseen by a Steering Group representing the Department of Health and Children, the Department of the Taoiseach, the Department of Finance and the health boards. The Steering Group had overall responsibility for the consultation process.

A Project Team comprising officials of the Department of Health and Children and the health boards was established to work to the Steering Group and produce the Strategy document.

The Minister established a National Health Strategy Consultative Forum representative of key stakeholders to support the Steering Group by providing advice on the key themes and direction of the Strategy and on the process for its preparation. It proved to be a valuable means of discussion that underpinned the entire consultation process.

In addition to the plenary sessions, the Forum was divided into eight working groups to deal with specific issues: funding, eligibility, delivery systems/human resources, population health, quality, voluntary/statutory interface, e-health and futures in health care.

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Consulting the stakeholders

The public

In view of restrictions on travel in the early part of 2001 due to foot-and-mouth disease, the main means of consulting with the general public was through the consultation pack Your Views about Health. Members of the public and organisations were invited, by means of a questionnaire, to describe their experiences of the health services and to give their views on future change.

Over 1,500 submissions were received from members of the public.

The Department of Health and Children also commissioned Irish Marketing Surveys to carry out market research. This research included a quantitative and qualitative survey involving a nationally representative sample of 2,000 adults.

Organisations

A number of organisations participated in the process by completing the questionnaire Your Views about Health, referred to above. Others submitted independent submissions setting out their views in detail. A number of health boards arranged workshops for locally-based organisations.

Over 300 submissions were received from organisations.

Health services personnel

Extensive and detailed consultation was undertaken in each of the ten health board areas. In addition, a number of health services staff completed the questionnaire Your Views about Health. Consultation also took place with staff in the Department of Health and Children.

People living in poverty

In the case of people living in poverty, a separate consultation process was undertaken through the National Anti-Poverty Strategy (NAPS).

Links with the development of the Strategy

The material contained in the questionnaires and in submissions fed into the process of developing the Strategy in a number of ways:

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Key themes emerging from the consultation process

A whole-system approach to health

High priority is given to the promotion of health and prevention of illness in a way that empowers individuals and communities to take responsibility for their lives and their health and which provides the supports they need for that task. There is consensus that health promotion must be viewed broadly, encompassing education, housing, income support, provision for leisure, mental health, as well as complex structural issues such as poverty and marginalisation. The feedback also underscores the strategic and long-term benefits of giving children and young people the information, facilities and supports needed to optimise their health and well-being.

Going beyond 'more'

The need for more investment at all levels is a theme that emerges throughout the consultation process. Linked with this need for more resources, however, is the need for strategic change around how the health system is experienced by the public. The changes envisaged centre on fairness, equity of access, quality of care and quality of people's experience of the health system, and the provision of holistic and seamless services.

Towards a holistic and seamless service

A strong strategic focus is on a health system that is responsive to the whole person and his or her well-being. Such a system envisages full integration of services that place the person at its centre. There is a clear understanding that existing system rigidities ­ in attitudes, contractual arrangements, service delivery systems and boundaries between agencies and funding mechanisms ­ must be addressed if the new person-centered ethos is to permeate the health system.

A focus on community

There is a strong focus on providing care in the community. There are numerous proposals for developing a new model for delivering health care in the community, the availability of a wider range of services, developing the role of the general practitioner, and improved linkages within and between services.

The focus on community is strongly evident in the priority given to providing services in the community to vulnerable groups such as older people and people with disabilities. The need for rural transport is highlighted consistently.

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A fair health system

One of the key findings from the consultation process is that there is a strong will to change what is perceived to be an inequitable system, particularly in the case of access to hospital treatment and specialist care. There is also concern about geographic disparities and access to services for vulnerable and/or marginalised groups such as older people, people with mental health difficulties, the homeless and ethnic minorities.

Delivering high quality of care, treatment and support

The future development of the health system must place a very high premium on the quality of service provided.

Respectful relationships

The theme of respectful relationships is evident in the consultation process. Reported experiences of disrespect or poor communication make a strong and lasting impression. Strategies to address this issue include increasing staffing levels so as to remove some of the pressure on staff, training and development programmes for health service personnel in customer services, effective complaints and appeals procedures, anti-ageism, disability awareness programmes and culturally sensitive information services and practices.

There are two significant strands to this theme. One is mutual respect in the relationships between the groups who make up the health system ­ service providers, users, advocacy groups, policy makers, funders, staff and employers. The second is the need for supporting the staff in the health services through a human resources strategy that would place a high priority on promoting the well-being of health service personnel.

Full details of the messages from the consultation process are contained in the report on consultation Your Views about Health.

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Appendix 2

Recent Strategies and Policy Documents

1 Cancer Services in Ireland: A National Strategy (1996) - Actions 5, 12 and 56

The National Cancer Strategy was published in 1996 and was followed by a 3-year action plan in 1997. The main elements of the Strategy involved:

Since 1997, major progress has been made in implementing the National Cancer Strategy. The National Cancer Forum has been established to advise on the implementation of the Strategy. Regional directors of cancer services in each health board area were appointed to prepare regional cancer plans and to oversee their implementation. The first phase of a national programme of screening for breast cancer is in place and the National Cervical Screening Programme was launched in 2000. Specific cancer research funding has been provided and a cancer consortium involving Ireland, Northern Ireland and the National Cancer Institute (USA) has been established to develop joint cancer research projects, scholar exchange programmes and a range of other collaborative activities.

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2 Best Health for Children (1999) - Actions 8, 14 and 27

Best Health for Children involved a co-ordinated partnership approach by the health boards to protecting and promoting children's health. The initial part of Best Health for Children is concerned with promoting health in younger children and, in particular, the role of screening and surveillance and the development of parenting, education and support.

3 The National Health Promotion Strategy 2000-2005 - Action 5

This strategy recognises the need to improve the health and social gain of those who are disadvantaged or from lower socio-economic groups by developing sensitive and appropriate health promotion programmes to meet their needs. Key priorities are to

The National Health Promotion Strategy outlines three major strands for the future development of health promotion

The new National Health Promotion Forum will provide an effective platform to tackle inter-sectoral approaches to the major determinants of health which are set out in detail in the Strategy. The Strategy informs the future direction and focus for the Department's Health Promotion Unit and the health boards for the next five years. It also provides a resource and guide for relevant partners, statutory and non-statutory, concerned with promoting positive health in the new millennium.

4 Towards a Tobacco-Free Society (2000) - Action 6

The Minister for Health and Children established a policy review group to carry out a fundamental review of smoking and health policy. The Government approved the publication of the report of the group, Towards a Tobacco-Free Society, and the preparation of a new Bill to implement its recommendations. The report sets out Government policy on reducing the incidence of smoking. The Government approved the drafting of the Public Health (Tobacco) Bill and agreed to give the Bill priority in the Government's legislative programme. The text of the Bill was published in August 2001.

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5 The Health of Our Children (2001) - Actions 8, 9, 14 and Chapter 6

The Second Annual Report of the Chief Medical Officer of the Department of Health and Children is concerned with children's health in Ireland. The report acknowledges the very important contribution of services that are being provided by way of cure and rehabilitation for children with health needs. However, it argues for greater emphasis on prevention and health promotion in our approach to children's health.

In preparing a new health strategy the report calls for specific consideration to be given to eligibility for services for children, a national strategy to prevent accidents in childhood and measures to reduce the availability and consumption of tobacco, alcohol and illicit drugs by children.

The report also reviews progress in relation to many of the issues highlighted in the First Annual Report of the Chief Medical Officer including cancer, cardiovascular disease, communicable disease and in particular health inequalities.

6 Cardiovascular Health Strategy (1999) - Actions 5, 13 and 56

The Cardiovascular Health Strategy, Building Healthier Hearts, was launched in July 1999. It addressed the common aspects of prevention of cardiovascular disease, as well as the treatment and rehabilitation of patients with coronary heart disease. The following overall aims were identified:

The Department of Health and Children has set a medium-term objective to bring our levels of premature deaths from cardiovascular disease into line with the EU average at a minimum, and as a long-term objective to reduce our rates to those of the best performers in the EU. The Cardiovascular Health Strategy, which contains 211 recommendations, is designed to achieve these objectives systematically. Implementation of the recommendations will require substantial developments in health promotion (which is much broader than the health services), primary care, pre-hospital care, hospital care, cardiac rehabilitation and the audit and evaluation of services.

7 Our Children ­ Their Lives, The National Children's Strategy (2000) - Actions 8, 14 and Chapter 6

The National Children's Strategy sets out a common vision to work towards:

An Ireland where children are respected as young citizens with a valued contribution to make and a voice of their own; where all children are cherished and supported by family and the wider society; where they enjoy a fulfilling childhood and realise their potential.

Six principles are identified to guide all actions to be taken: actions should be child-centred, family-oriented, equitable, inclusive, action-oriented and integrated.

The Strategy proposes a more holistic way of thinking about children, a 'whole child' perspective, which reflects contemporary understanding of childhood. This perspective is used together with the outcome of the consultation to set three national goals for children:

The new structures being put in place to implement the Strategy include:

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8 Adolescent Health Strategy (2001) - Action 14, and Chapter 6

The Adolescent Health Strategy is based on the deliberations of a sub-committee of the national conjoint child health committee, which was appointed by health board CEOs to make recommendations on a number of issues pertaining to adolescent health. The first part of the strategy highlights:

The second part introduces the concept of the adolescent-friendly health service, the key elements of which are:

9 Report of the Review Group on Child and Adolescent Psychiatric Services (2001) - Actions 14, 25 and Chapter 6

A working group to advise the Minister for Health and Children on the development of child and adolescent psychiatric services was established in June 2000. Its first report was published in March 2001 and includes recommendations on how services should be developed in the short, medium and long term to meet the needs of those under the age of 18. It analysed two specific areas ­ the organisation of services for the treatment of Attention Deficit Hyperactivity Disorder/Hyperactivity Kinetic Disorder (ADHD/HKD) and the provision of child and adolescent psychiatric in-patient units.

The report emphasises that the treatment of ADHD/HKD is an integral component of the provision of a comprehensive child and adolescent psychiatric service. It recommends that priority should be given to the recruitment of the required expertise for the completion of existing consultant-led multi-disciplinary teams and calls for closer liaison with the education system and other areas of the community health services.

The report also recommends that a total of seven child and adolescent in-patient psychiatric units for children ranging from 6-16 years should be developed throughout the country. It is envisaged that the focus of the centres will be the assessment and treatment of psychiatric, emotional or family disorders.

10 National Drugs Strategy (2001) - Action 22

The National Drugs Strategy was prepared by the Department of Tourism, Sport and Recreation and launched in May 2001. Its overall aim is to provide an effective, integrated response to the problems posed by drug misuse. Three basic principles underpin the strategy:

Arising from these principles, the key objectives are:

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11 Report of the National Advisory Committee on Palliative Care (2001) - Action 31

Palliative care is the continuing active total care of patients and their families at a time when the medical expectation is no longer a cure. It responds to physical, psychological, social and spiritual needs, and extends to support in bereavement.

The National Advisory Committee on Palliative Care comprised representatives from the medical and nursing profession working in palliative care, hospice administrators, representatives of the Irish Hospice Foundation, the Irish Cancer Society and the Department of Health and Children.

The report describes the components of a comprehensive palliative care service and acts as a blueprint for its development. Among the report's recommendations are that each region should have a specialist palliative care unit. Such units would act as a specialist resource for the delivery of palliative care services in the hospital and in all care settings across the region. The report makes recommendations on estimated bed number requirements for these units. There are also comprehensive recommendations on how palliative care services in all settings should be staffed.

The report underlines the particular needs of specialist palliative care settings in relation to physical structure and environment. It recommends that an expert group on design guides for specialist palliative care settings be established.

12 National AIDS Strategy (2000) - Action 33

The report of the National AIDS Strategy Committee, AIDS Strategy 2000 was launched in June 2000.

It comprises the reports of four sub-committees of the National Committee:

In the report each of the sub-committees examines progress made since 1992 and makes recommendations for future action, which have been endorsed by the National Committee. An important point to emerge from the reports is that HIV/AIDS should now be dealt with in the wider context of sexual health and other sexually transmitted infections.

The introduction of routine antenatal testing for HIV in 2000 means that where a pregnant woman tests positive for HIV she can avail of treatments that greatly improve the outcome for herself and her baby. One of the challenges for the future is to have as high an uptake as possible for this programme.

13 Programme for Prosperity and Fairness (2000) - Action 37

The Programme for Prosperity and Fairness (PPF) is the fifth national agreement between the social partners, and follows on from the Programme for National Recovery, the Programme for Economic and Social Progress, the Programme for Competitiveness and Work, and Partnership 2000.

The PPF aims to:

The PPF is dependent upon achieving an average annual GNP growth rate of about 5.6 per cent over the period of the Agreement and a goal of maintaining significant budgetary surpluses in each year.

The PPF recognises the need to provide quality health care services for people who are ill or who have disabilities. Emphasis is placed on improving quality of life through targeted health promotion and preventive strategies. Measures will include:

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14 Making Knowledge Work for Health ­ National Health Research Strategy (2001) - Action 73

The National Health Research Strategy proposes a thriving research culture supported by two complementary but distinct pillars:

It emphasises that we are on the eve of one of the most remarkable transformations of the understanding of the human body and of health and disease. Knowledge will become available as a consequence of the mapping of the human genome and other discoveries. This transformation in knowledge will generate much more effective means to protect health and combat disease.

Making Knowledge Work for Health is the result of intensive consultation over a two-year period involving health providers, the universities and third-level colleges, the research community, the voluntary sector and the health-care industry. Its proposals reflect a consensus on how the health service should create, transfer and apply knowledge to promote health, combat disease and make services more effective. It develops the thinking of the White Paper on Science, Technology and Innovation (1996) and the Technology Foresight Report of the Irish Council for Science, Technology and Innovation (1999) in the context of the health services.

The analysis and proposals in the document are central to supporting a knowledge-based approach to health, guaranteeing better quality services to patients, ensuring more effective delivery of health services and creating a high-quality training environment for young health professionals. These are cross-cutting issues that are relevant to all aspects of the new Health Strategy. (Further details of the National Health Research Strategy are contained in Chapter 4.)

15 National Development Plan 2000-2006 (1999) - Chapters 3 and 5

The National Development Plan (NDP) involves an investment of over £40 billion (€52 billion) of public, private and EU funds (in 1999 prices) over the period 2000-2006. It is the largest and most ambitious investment plan ever drawn up for Ireland. The plan will involve significant investment in health services, social housing, education, roads, public transport, rural development, industry, and water and waste services. Unlike previous plans most of the public funding for this plan (about 90 per cent) will be provided from domestic sources, mainly from the Exchequer. The contribution from the EU will total £4.7 billion (€6 billion)

The NDP will involve a total capital investment of £2 billion (€2.5 billion) in the health sector. The priorities for this investment are:

16 National Health Information Strategy (forthcoming) - Action 115

In April 2000, the Minister for Health and Children announced the development of a National Health Information Strategy (NHIS) to provide a blueprint for gathering and using information for health. The aim is to produce a strategy that will guide the development of a co-ordinated and integrated health information system over the next 5-7 years, and that is responsive to the health information needs of stakeholders - the public, patients, carers, health professionals, service managers and policy makers. The NHIS will support and complement this Health Strategy.

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Appendix 3

Health agencies

Statutory bodies and non-statutory organisations

Body Function
An Bord Altranais (Nursing Board) The regulatory body for the nursing profession. Its main functions are to maintain a register of nurses and to provide for the education and training of nurses and student nurses
An Bord Uchtála (Adoption Board) Makes Adoption Orders and registers voluntary adoption societies
Board for the Employment of the Blind Provides employment for a number of blind and visually impaired people
Bord na Radharcmhastóirí (Opticians Board) The regulatory body for opticians. The board's main functions include the training and registration of ophthalmic and dispensing opticians and regulating the practice of optics
Breastcheck Responsible for the National Breast Screening Programme that aims to reduce breast cancer related deaths in women
Comhairle na Nimheanna (Poisons Council) Advises the Minister for Health and Children on the control of poisons
Comhairle na nOspidéal The statutory body responsible for regulating the number and type of consultant and senior registrar appointments and for specifying the necessary qualifications for these posts
Dental Council The regulatory body for the dental profession. Its functions include maintaining a register of dentists and dental specialists, ensuring that the standards of dental training are maintained and inquiring into the fitness of a dentist to practice on specific grounds
Drug Treatment Centre Board Provides a range of programmes for the treatment of drug addiction
Food Safety Authority of Ireland Provides advice on issues relating to safety, nutrition, food law and other matters regarding the processing and sale of food
Food Safety Promotion Board A North/South institution which promotes food safety awareness. It also supports north/south scientific co-operation, promotes links between institutions working in the field of food safety and promotes specialised laboratory services
General Medical Services (Payments) Board Administers payments to doctors and pharmacists under the GMS scheme
Health Research Board Provides advice on health research and related matters
Health Services Employers Agency (HSEA) A statutory agency representing health service employers. Its functions include the promotion and support of value for money, efficiency and effectiveness in employment practice and the negotiation of industrial relations issues with health unions
Hospitals Trust Board Administers the Hospitals Trust Fund
Institute of Public Health (IPH)
A cross-border body established by the Department of Health and Children and the Department of Health, Social Services and Public Safety (NI). The IPH is concerned with tackling health inequalities, strengthening partnerships and networking nationally and internationally, contributing to public health information and surveillance and strengthening public health capacity
Interim Special Residential Services Board Advises the Ministers for Health and Children and Education and Science on matters relating to children in respect of whom child detention or special care orders have been made by the courts
Irish Blood Transfusion Service Organises and administers the national blood transfusion service including the processing and supply of blood and blood products to Irish Hospitals. It also operates the National Haemovigilance Office, the Irish Unrelated Bone Marrow Registry and the National Tissue Bank
Irish Medicines Board The authority responsible for the licensing of human and veterinary medicines and the approval of clinical trials. It also acts as an advisory body to the Minister in relation to safety, control and regulation of medicines generally
Medical Council The statutory body for the medical profession. Its functions include administering the General Register of Medical Practitioners, ensuring that the standards of medical training are maintained and inquiring into the fitness of a doctor to practise on specific grounds
National Cancer Registry Board A statutory body established to collect and analyse data and to report on cancer incidence and mortality in Ireland
National Children's Advisory Council

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Advises the Minister for Health and Children on all aspects of children's lives, on better delivery and co-ordination of services to children, contributes to monitoring and evaluation of implementation of the National Children's Strategy, undertakes and advises on research and advises on the development of mechanisms to consult with children

 

National Children's Office Responsible for the implementation of the National Children's Strategy. It provides advice to the Minister for Health and Children, develops measures to further the goals of the strategy and is responsible for fulfilling Ireland's commitments under the United Nations Convention on the Rights of the Child
National Council for the Professional Development of Nursing and Midwifery The body responsible for the continuing education and professional development of nurses and midwives
National Council on Ageing and Older People Advises the Minister for Health and Children on all aspects of ageing and older people
National Disease Surveillance Centre (NDSC) Ireland's specialist centre for surveillance of communicable diseases. The aim of NDSC is to improve the health of the Irish population by the collation, interpretation and provision of the best possible information on infectious diseases. This is achieved through surveillance and independent advice, epidemiological investigation, research and training
National Social Work Qualifications Board A statutory body which assesses the suitability of social work education and training and advises the Minister for Health and Children on standards which should apply
Office for Health Gain (OHG) A body established by health board chief executive officers to facilitate health boards and others working to achieve health gain in response to the 1994 health strategy
Office for Health Management (OHM) A body established to implement the national strategy for management development for the health and personal and social services in Ireland. Its main function is to facilitate management development for the health services by acting as a central resource and commissioning body
Office of Tobacco Control/Tobacco Control Agency (proposed) Established on an administrative basis pending legislation. The Public Health (Tobacco) Bill provides for the establishment of a Tobacco Control Agency to advise the Minister on tobacco control measures, to monitor and co-ordinate the implementation of such measures and to advise the Minister on the control and regulation of the manufacture, sale, marketing and smoking of tobacco products
Pharmaceutical Society of Ireland The professional body for the pharmaceutical profession. Its chief functions relate to the education, examination and registration of pharmaceutical chemists
Postgraduate Medical and Dental Board Promotes and co-ordinates postgraduate medical and dental education and advises the Minister for Health and Children on all matters relating to such education
Pre-hospital Emergency Care Council Responsible for the recognition of institutions for the education and training of emergency medical technicians
Social Services Inspectorate (SSI) Established in 1999 by the Department of Health and Children as an independent body to inspect social services provided by health boards. To date the SSI has focused on child care services
Women's Health Council Advises the Minister for Health and Children on all aspects of women's health

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Health boards

Health boards were established under the Health Act, 1970 for the administration of the health services in the State. Health boards replaced local authorities in fulfilling this role. There are currently ten health boards established: three area health boards located in the eastern region under the aegis of the ERHA and seven regional health boards covering the rest of the country.

Eastern Regional Health Authority (ERHA)

The ERHA plans, commissions, monitors and evaluates health and personal social services in the eastern region, covering counties Dublin, Wicklow and Kildare, from the three area health boards and other providers located in the region. The three area health boards in the region are responsible for the provision of health and personal social services in their area:

erha boards

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Regional health boards

The seven regional health boards are responsible for providing or arranging the provision of health and personal social services in the following counties:

health boards

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Glossary of terms

Acute hospital: A hospital providing medical and surgical treatment of relatively short duration. All, except district hospitals, are consultant-staffed. District hospitals are classified as acute where the average length of stay is less than 30 days

Advanced nurse practitioner/ advanced midwife practitioner: Advanced nursing and midwifery practice is carried out by autonomous, experienced practitioners who are competent, accountable and responsible for their own practice. They are highly experienced in clinical practice and are educated to masters degree level (or higher)

Advocacy service: Assigns someone who represents and defends the views, needs and rights of an individual who is not in a position to or does not feel able to do this for him or herself

Alternative medicine: A broad range of healing resources that encompasses health systems and practices, that are seen as alternative to conventional medicine or health care, as well as the theories and beliefs that underlie them

Autologous transfusion: A transfusion in which the donor and recipient are the same person and which uses pre-deposited blood and blood products

Bed designation: The assigning of beds in public hospitals for sole use by public or private patients

Capital funding: Money allocated for spending on assets, such as buildings or equipment, which will be used for more than one year

Care plan: A plan formulated by a health professional in consultation with individual patients, their families and other appropriate professionals that describes what kind of services and care that person should receive

Casemix: A method of quantifying hospital workload by describing the complexity and resource-intensity ofhe services provided. This differs from a simple count of total patients treated or total bed days used

Childcare: Describes day-care facilities and services for pre-school children and school-going children out of school hours

Child care: The services under the remit of the Department of Health and Children for children who require care and protection from the State

Clinical audit: The systematic, critical analysis of the quality of care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient

Clinical nurse specialist / Clinical midwife specialist: A nurse or midwife specialist in clinical practice who has undertaken formal recognised post-registration education relevant to his or her area of specialist practice at higher diploma level. Such formal education is underpinned by extensive experience and clinical expertise in the relevant specialist area

Clinical pathways: A method used in health care to organise, evaluate and limit variations in patient care. This method integrates the components of the care plan into one which addresses the needs and services provided to the whole patient

Consultant-led service: A service supervised by consultants who lead and advise teams of doctors in training and other staff in the delivery of care to their patients

Consultant-provided service: A service delivered by consultants, working in teams, who have a substantial ­ and direct - involvement in the diagnosis, delivery of care and overall management of patients

Council of Europe: An intergovernmental organisation, of which Ireland is a member. The Council of Europe is concerned with the protection and promotion of human rights and democracy throughout Europe, and with strengthening political, social, legal and cultural co-operation among its member states

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Day patient: A person admitted to hospital for treatment on a planned (rather than an emergency) basis and who is discharged on the same day

Defibrillation: The use of a carefully controlled electric shock, administered either through a device on the exterior of the chest wall or directly to the exposed heart muscle, to restart or normalise heart rhythms

Diagnostic: Pertaining to the determination of the nature of a cause of disease

Discharge planning: The active planning of discharge and post-discharge services for in-patients

Elective treatment: A planned or non-emergency admission or procedure that has been arranged in advance. This differs from emergency treatment that is urgently required

Eligibility: Refers to whether or not a person qualifies to avail of services, either without charge (full eligibility) or subject to prescribed charges (limited eligibility)

Entitlement: A right granted by law or contract, especially to benefits or services

Environmental health: Comprises those aspects of human health and disease that are determined by factors in the environment. It also refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health

Evidence-based practice: Practice which incorporates the use of best available and appropriate evidence arising from research and other sources

Gross domestic product (GDP): The total output produced in the Irish economy regardless of the residence of the owners of production. It includes output by foreign-owned producers located in Ireland, but does not include output by Irish-owned producers located abroad

Gross national product (GNP): The total income earned by residents of a country irrespective of where that income is generated. It is equal to GDP plus income earned abroad by Irish residents, less income earned in Ireland by foreign residents

Health and personal social services: Services provided by public, private and voluntary agencies that are aimed directly at improving health status

Health system: The term used to describe agencies that provide health services or whose actions have an impact on health

HESSOP Report: The Health and Social Services for Older People report conducted by the National Council for Ageing and Older People. Older people were consulted on their service needs and their use and experiences of current services

Hospital in-patient enquiry (HIPE): A health information system that collates data about each in-patient and day care hospital discharge, including diagnostic and treatment information and length of stay

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Interdisciplinary or multidisciplinary approach: The term used to describe professionals from more than one discipline working together in a co-ordinated way

Intersectoral or multi-sectoral issues: The term used to describe policy issues that involve more than one department or agency and may require a co-ordinated approach

In-patient: A person admitted to hospital for treatment or investigation who stays for at least one night

Key worker: A designated person assigned to an individual or family who acts as a liaison with outside agencies, co-ordinates social and health services and acts as a resource person for their clients

Morbidity Rate: The number of ill people in a given population in a particular time period

Mortality Rate: The number of deaths in a given population in a particular time period

Multi-annual budgeting: A system of budgeting where money is allocated for a project for more than one year. In effect a budget is agreed for each year over the lifetime of a project and the agreed level of funding is guaranteed for this period. A multi-annual budget (MAB) is a budget for a project covering more than one year

National Anti-Poverty Strategy, 1997: A 10-year Government programme for reducing poverty through a range of targets focusing on global poverty, educational disadvantage, unemployment, income adequacy and rural/urban development. The Programme for Prosperity and Fairness committed the Government to setting targets in the area of health, housing and accommodation

National Development Plan 2000-2006: The plan sets out a coherent strategy for development in the areas of infrastructure, education and training, the productive sector and the promotion of social inclusion. It includes a framework for the promotion of a more balanced regional development. It will involve an investment of £40 billion (E52 billion) over the period 2000-2006 of public, EU and private funds. A total of £2 billion (E2.5 billion) has been allocated to the health sector

National psychiatric in-patient reporting system (NPIRS): A database with details of all discharges from public in-patient units for persons with mental illness

Out-of-hours service: Services provided outside 'traditional' business hours, i.e. before 9am and after 5pm on weekdays and all services provided during weekends and bank holidays

Out-of-pocket: Funding for a service that is received through direct payments to the service provider by users

Out-patient: A patient who attends a hospital clinic for treatment and is not admitted to the hospital

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Palliative care: The active total care of patients whose condition is no longer responsive to curative treatment

Personal public service number (PPSN): Unique personal reference number for the public service, including social welfare, tax, education and health service eligibility

Primary care: An approach to care that includes a range of services designed to keep people well, from promotion of health and screening for disease to assessment, diagnosis, treatment and rehabilitation as well as personal social services. The services provide first-level contact that is fully accessible by self-referral and have a strong emphasis on working with communities and individuals to improve their health and social well-being

Public Private Partnerships (PPP): An agreement between a public authority and a private sector business for the purpose of designing, building and possibly operating a capital development or service which is traditionally provided by the public sector. The use of PPPs in the health sector will be used to help accelerate capital provision, yield long-term value for money for the Exchequer and ensure quality public services

Purchasing power parity: The adjustment made between the currencies of different countries to reflect differences in exchange rates. The purchasing power parity (PPP) rate enables more valid comparisons to be made between relative prices when these are measured in a common currency. Health spending comparisons are often expressed in US$, in PPP terms

Risk management: The prevention and containment of liability by careful and objective investigation and documentation of critical or unusual patient care incidents

Secondary care: Specialist care that is typically provided in a hospital setting

Service agreement: A formal agreement between a health board and a voluntary agency in which the board provides funding in exchange for an agreed level and type of service

Shared care: Continuing care for those with on-going needs which is usually provided by both primary and secondary care providers

Social capital: Those stocks of social trust, norms and networks that people can draw upon to solve common problems. These include organised supports such as parish and neighbourhood associations, sports clubs and co-operatives and less formal supports such as close neighbours and extended family

Social, Personal and Health Education (SPHE): Introduced in the late 1990s to drive all school programmes relating to lifestyle choices. SPHE has formed part of the Primary School Curriculum since 1999 and is being introduced on a phased basis at junior cycle level from October 2000. All post-primary schools will have a programme in place by September 2003

Specialist services: Care delivered by consultants and other specialist health care professionals in a hospital or community setting

Strategic Management Initiative (SMI): The initiative launched by the Government in 1994 to reinvigorate the management and performance of the public service

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Telemedicine: Rapid access to shared and remote medical expertise by means of telecommunications and information technologies, no matter where the patient or relevant information is located

Tertiary care: Very specialised care, normally confined to a small number of locations

Triage: The initial rapid assessment of patients in order to direct them to the service appropriate to their needs

Value for money (VFM): Examinations carried out by the Comptroller and Auditor General (C&AG) that aim to establish whether resources have been acquired, used or disposed of economically and efficiently. Examinations can also investigate whether public bodies have appropriate systems, practices and procedures for evaluating the effectiveness of their activities

vCJD: variant Creutzfeldt-Jakob Disease

Whole-time equivalent numbers: A measure of the number of people working in an organisation which takes into account the number of hours worked by both full and part-time staff and expresses this in terms of the number of people working full-time that it would take to carry out the same work. In its simplest form two part-time workers are deemed to be equivalent to one whole-time equivalent

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