North Western Health Board annual report 1983 submitted to the Board on the 16th July 1984

Item Type Report

Authors North Western Health Board (NWHB)

Publisher North Western Health Board (NWHB)

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Annual Report 1983 North Western Health Board Area Location of Principal Centres.

A Headquarters

8 General Hospitals c District Hospitals D Community Hospitals

E Psychiatric Hospitals

F Geriatric Hospitals

G Residential/ Pre-School/ Day Centres for Mentally Handicapped

H Welfare Homes

Community Care Offices

J Community Nursing Units

K Training Centres

Printed and Typeset by the N. W.H.B., Training Centre, Ballyraine, Letterkenny. Tharisc Bliana 1983 Annual Report Submitted to Members of North Western Health Board at Annual General Meeting on 16th July, 1984.

Os Comhair belli Bord Slainte An tar - Thuaiscirt Ag Cruinnh'J Chinn - bhllana 16u lull, 1984. CONTENTS

Chair(Tlan's Report 3 Membership of the Board 4 Board Management Team 4 Local Health Advisory Committee 5 Hospital Care B Community Care 23 Personnel 43 Finance 47 Technical Services and European Social Fund 55 Appendices (Hospital Care) 57 Appendices (Community Care) 67 Chairman's Report CHAIRMAN'S ADDRESS

The yHr 1983 hss SHn the contlnu•tlon of the p11ttsm of recent ytMrs whh • further reduction In ,.., terms of the &»rei's fln•ncl•l•lloCIItlon, •ccoinp•nled by lncTNslng p18ssu/8 on existing services and demllnds for sddhlonlll services. The absence of an y overall national policies or str•ttlfi/N In Mr. T. Lsvin, M. C. C., Chairman of the N. W:H.B. dNIIng whh these tl8nds, puts the onus on 1983184. th/$ Board to cope with these strains and I decide priorities. In general, the budgets of the community services were maintained, while the service budgets In the hospltels had to btHir the brunt of the cutback. Whhin this policy, lt was possible to make some limited Improvements during the yHr In selected services for the disabled, the homeless, deprived chlldftln and the llfled. The unacceptable condhlons which apply In Sligo General Hosphsl, and which at the end of 1982 SHmed well on the way to resolution, ftlmllln whh us. The Board was faced Hr/y In 1983 whh • Government decision not ro procHd whh the project. However, following commlttments given by the hospital management and st•ff on ftlvsnue consequences, and • rapid,. examination of the project whh • view to achieving • phased approach, the planning process has been resumed, whh • timetable to complete contract documents by the end of 1984. This project has bHn for yHrs, and l'fH'nBins our first hospital prlorhy. Whhln 1/mhed ,.sources, Improvements have continued In the psychiatric services and In services for the aged, and are detailed In this report. Being parochial, I must record particular pleasure at the commencement of work on tf?e replacement of the Nursing Home In S.llymote, • unit which has long been condemned by the Fire Authorities. The development and expansion of the Board's Lifesk/1/s programme lit the second level schools Is welcome and timely, and has crested widespread u tlsfsctlon among school authorities, tHchers, psftlnts and the general public. The year also uw the opening of an aids display and general Information service for the handicapped. Once again, the Board's thanks go to the members of • hundred voluntBfY organisations throughout the region for their unselfish work and their co-operation with us; In this yHr I must p11y tribute to the groups who raised funds to help In •cqu/ring equipment for the 18nBI dialysis service at SHgo and Lettllrlcenny. The staff have once again, Cllrried out their worlc well despite TNtrlctlons and cutbacks, and have maintained an exceptionally high level of stHY/ce. And to our members of the Board I offer my thanks for committment and dedication. h Is little realised how much time and effort .,. put into the work of the Board and its committees by the members, work dons willingly •nd without financial 18WBrd, for the public. But there Is satisfaction for us ell In maintaining In our hHhh servlce:t the high standards that have bHn achieved heftl.

3 Membership of the Board and Management Tham MEMBERSHIP OF N.W.H.B.

Mr. T. Lavin, M .C.C., Chairman. ' t Mr. H. Conaghan, T.D. Vice-Chairman. Miss M. Bonner. Dr. M. Cooney. Mr P.J. Cawley, M.C.C. Mr. Tom Deignan. M.C.C. Dr. P. Dockry. Mr. W. Farrell, M .C.C. Dr. S. Geraghty. Mr. M. Guckian, M.C.C. Mr. P. Harte, T.O. Mr. E. Henry, M.C.C. Mr. J. J. Hamilton. Mr. J. Loughlin, M.C.C. Mr. M . Melly, M.C.C .. Dr. J. McCioskey. Dr. B. McOonagh. Dr. F.C. McAteer. Or. A . McFarlane. Mr. N. McGinley, M.C.C. Miss S. McGonagle, M .C.C. Mr. B. McGiinchey, M.C.C. Mr. L. McGowan. M .C.C. Mr. P. McKeon, M .C.C. Mr. P. O' Donnell. Rev . Canon C. Thornton. Fr. J. Young.

MEMBERSHIP OF MANAGEMENT TEAM N.W.H.B. Mr. D. O'Shea, Chief Executive Officer. Mr. M. Mcloone, Programme Manager Community Care. Mr. M. Ward, Programme Manager Hospital Care. Mr. M. Lynch, Personnel Officer. Mr. D. McDermott, Technical Services Officer. Mr. M . Kenny, Planning and Evaluation Officer. Mr. J. Murphy, Finance Officer.

4 Local Health Advisory Committees I MEMBERSHIP OF LOCAL HEALTH ADVISORY COMMITTEES.

DONEGAL LOCAL HEALTH ADVISORY COMMITTEE:­ CIIr. C. Gallagher, Chairman, Mountcharles, Co. Donegal. Mr. S. Cleary, Mouncharles, Co. Donegal. Cllr. S. McBride, Carnigrave, Moville, Co. Donegal. Cllr. Edward J. Fullerton, 66 Cockhill Park, Buncrana. Cllr. Paddy Keavney, ' Loreto', Moville, Co. Donegal. Cllr. Brian Gallagher, Mountcharles, Co. Donegal. Cllr. Michael J . Melly, East Port, Ballyshannon, Co. Donegal. Cllr. Fred Coli, Derrybeg, Co. Donegal. Cllr. Patrick Delap, Bunbeg, Co. Donegal. Cllr. J. k'elly, Falcarragh, Co. Donegal. Cllr. S. McGonagle, Main St., Ballybofey, Co. Donegal. Cllr. P. McGowan, Edenmore, Lifford, Co. Donegal. Cllr. J . J . Reid, Knockfair, Ballybofey, Co. Donegal. Cllr. Harry J. Blaney, Rossnakill, Letterkenny, Co. Donegal. Senator J . Anthony Loughrey, Kerrykeel, Co. Donegal. Cllr. N. McGinley, Ballyboes, Creeslough, Co. Donegal. Dr. M. F. Cooney, Director of Community Care & Medical Officer of Health, Community Care Offices, Ballybofey, Co. Donegal. Mr. F. Maloney, County Manager, Donegal Co. Council. Dr. B. Callaghan, Consultant Physician, General Hospital, Letterkenny. Dr. B. Forkin, Stranorlar, Co. Donegal. Dr. W. J. Wray, Ballyholey, Raphoe, Co. Donegal. Mr. C. Gallen, Psychiatric Nurse, St. Canal's Hospital, Letterkenny. Dr. M . McMenamin, Dun7Emer, Stranorlar, Co. Donegal. Mr. J. P. Duffy, M.P.S.I., Buncrana, Co. Donegal. Mr. Leo Friel, Superintendent Community Wefare Officer, Ballybofey. Mr. F. Callaghan, Main St., Buncrana, Co. Donegal. Mrs. A . Kelly, Superintendent Public Health Nurse.

5 ·------LEITRIM LOCAL HEALTH ADVISORY COMMITTEE

Councillor M. Bohan, Main Street, Drumkeeran. Councillor D. Brennan, Drumlegga, Cloone. Councillor J. Clinton, Carrowlaur, Drumkerran. Councillor K. Coleman, Main Street, Carrick-on-Shannon. Councillor C. Cullen, Minkeeragh, Glenfarne. Councillor F. McEigunn, Summerhill, Carrick-on-Shannon. Councillor T. Ferguson, Dooard, Rossinver. Councillor H. Flynn, Screeney, Manorhamilton. Councillor J . J. McGirl, Main Street, Ballinamore. Councillor M. Kilraine, Drumboy, Mohill. Councillor P. McKeon, Drumdoo, Mohill. Councillor J. Mclaughlin, Fawnlion, Fivemilebourne. Councillor J . Mooney, Drumshambo. Senator P. . J. Reynolds, Main Street, Ballinamore. Councillor J. J. Shortt, lisagarvan, Ballinamore. Dr. Heagney, Director of Community Care, Markievicz House Sligo. Mr. P. Doyle, County Manager, Courthouse, Carrick-on-Shannon. Dr. S .. Geraghty, Resident Medical Supt., St. Calumba's Hospital. Mr. N. Rowe, Superintendent Community Welfare Officer. Dr . P. McManus, "Grove House", Manorhamilton. Mr. J . l. McGowan, Psychiatric Nurse, St. Calumba's Hospital. Dr. D. loftus, Drumshambo. Mr. B. Kieran, M.P.S.I., Main Street, Carrick-on-Shannon. Mr. B. Healy, F.R.C.S.I., Orthopaedic Surgeon, General Hospital, Sligo. Sr. M. Delellis, P.H.N, St. Patrick's Hospital, Carrick-on-Shannon. Dr. P. J . Dockery, Senior Dental Officer, Cleveragh Road, Sligo. Miss B. Healy, McDermott Terrace, Manorhamilton. Mr. J . O'Donnell, Railway Road , Ballinamore.

6 SLIGO LOCAL HEALTH ADVISORY COMMITTEE

CLLr. Tony McLoughlin, Chairman, "Beechlawn", Barnasraghy, Sligo. CLLr. M. Brennan, T.D., Ragoora, Cloonacool, Tubbercurry, Co. Sligo. CLLr. P. J. Marren, Curry, Ballymote, Co . Sligo. CLLr. Peter Kivlehan, Belra, Lavagh, Ballymote, Co . Sligo. CLLr. Paul Conmy, Meenaun, Culleens, Co. Sligo. CLLr. Peter Barrett, Derk House, Dromard, Co. Sligo. CLLr. George Finnerty, Carrowmacbrine, Rathlee, Co. Sligo. CLLr. Leo Conlon, Coolmurla, Geevagh, Co. Sligo. CLLr. Gerard Murry, Calteraun, Gurteen, Co. Sligo. CLLr. Declan Bree, 13, Ash Grove, Maugheraboy, Sligo. CLLr. M. Gormley, Carrowloughlin, Bunninadden, Co . Sligo. CLLr. Ita Fox, Colgagh, Calry, Co. Sligo. CLLr. T. Higgins, 82, Treacy Ave., Sligo. CLLr. T. Deignan, Ardvarney, Riverstown, Co. Sligo. Dr. S. Geraghty, Chief Psychiatrist, St. Calumba's Hospital, Sligo. Mr. William Gilmartin, Psychiatric Nurse, St. Calumba's Hospital, Sligo. Mr. Paul Byrne, County Manager, Sligo County Council, Riverside, Sligo. Fr. C. Jones, Sligo Social Service Council, Charles St., Sligo. CLLr. Joe Shannon (Jnr), Mahanagh, Cloonloo, Via Boyle, Co . Sligo. Dr. T. Foley, Ard Caoin, Sligo. Dr. James Healy, Carniga, Ballincar, Sligo. Dr. Eileen Caulfield, Old Cartron, Sligo. Mr. E. Horan, 1 - 3 Castle St., Sligo. Mr. Philip O'Gorman, Tubbercurry, Co . Sligo. Dr. J. K. Heagney, Director of Community Care & M.O.H., Markievicz House, Sligo. Mr. N. Rowe, Superintendent Community Welfare Officer, Cleveragh Road, Sligo. Dr. P. Dockry, Senior Dental Officer, Health Centre, Cleveragh Road , Sligo. Mrs. K. Lyons, P.H.N., Markievicz House, Sligo.

7

HOSPITAL CARE PROGRAMME The hospital care programme consists of services provided by the Board's general, district and geriatric hospitals, psychiatric service and ambulance and transport service. The financial allocation for the prog~amme for 1 983 was again reduced on the previous year'S level. The expenditure incurred under each service was as follows:-

£M %of Total Health Board Expenditure General Hospital 1 .3 28% 3.8 6 % 3.4 5% 11 .6

During the year the Board and its Standing Committees on hospital services examined in detail various aspects of the services in the hospital care programme. The main reports considered by the Board during the year were:- 1983

February Ambulance and Transport Service March Accident and Emergency Service April Consultant Manpower May Admission/Discharge to Psychiatric Hospitals and Units May Orthopaedic Services June Hospital Pharmacy Services July Private Medical Practice - Board's Hospitals September District Hospital Services October Medico-Social Research Board Report November Accident and Emergency Services December Psychiatric Services - Sligo/Leitrim and South Donegal

STANDING COMMITTEE ON SPECIAL . HOSPITALS The standing committee on special hospitals visited each of the psychiatric and geriatric hospitals and examined the services provided in each location. During the year, the committee considered arrangements ar-1 developments in the following areas:- Community Psychiatric Nursing Social Club, Stranorlar Alternative Housing for Long-Stay Patients Psychological Services, Letterkenny Rehabilitation Services Development of Services for Aged Capital Development Schemes Alcoholism Child Psychiatric Services Hospital Farms 8 GENERAL HOSPITALS The designated General Ho1pltal1 In the Boards area ere Letterkenny General Hospital with e bed complement of 249 beds and Sligo General Ho.~pltal with a bed complement of 301 beds. The other hospitals providing service• within the General Hospital programme, complementary M the ·two designated General Hospitela,are Our Lady's Hospital, Menorhamllt~n and the district hospitals at Donegal, Belly,hennon, Dungloe, Lifford end Cerndonagh.

The specialist In-patient end out-patient services provided Include general medicine, general surgery, obstetrics, gynaecology, paediatrics, ophthalmology, E.N.T., qrthopaedlcs, anaesthetics Including Intensive care, radiology end pathology.

Out Patient Services at Letterkenny General Hospital, Co. Donegal

9 Despite the financial constraints placed upon the General Hospital services in the past year, admission to both General Hospitals continued its upward trend with a 3% increase (26, 133 to 26, 866) on the 1982 out­ turn. The table on pageJ 2 shows the trends In each specialty in Letterkenny and Sligo General Hospitals over the last three years.

The following are some of the important developments which have occurred in the General Hospital programme during 1983.

SLIGO GENERAL HOSPITAL DEVELOPMENT As approval was not given to the final plans and specifications for the hospital, as submitted to the Department of Health in November 1 982,a deputation appointed by the Board met the Minister on 16th May 1983 to emphasise the need for the development. Arising from this, a small planning group was appointed by the Minister to prepare a revised approach to the development of Sligo General Hospital, taking into account the current constraints on capital and revenue expenditure. The planning group completed its report within four months, proposing that the scheme should proceed in phases within the framework of the overall development control plan for the hospital. Phase I ( £1 9 Y2 m) of the development would consist of a somewhat modified multi-storey and interface building, comprising about two thirds of the cost of the total scheme. The modifications would mean that more than 80% of the needs of all departments and services in the hospital would be met in whole or in part in this phase, while the revenue consequences would be kept to a minimum.

The Minister accepted the proposals put forward by the planning group. A timescale of 12 morths was agreed with the Design Team and Department of Health officials for the completion of the detailed planning of the revisions and the final bills of quantities and contract documents. The final plans and documents are scheduled for completion in Mid - December 1984, and work is on schedule to allow this date to be met.

LETTERKENNY GENERAL HOSPITAL DEVEtOPMENT Phase 11 of the development was completed in July 1983 thus increasing the medical bed complement to its present level of 68 beds, and developing the Accident & Emergency department. Phase 11 of the development of the Hospital which includes radiology, pharmacy, out­ patients, stores and ambulance services was brought up to planning stage 3 level- that is layout and operational drawings and room details. Subsequently approval was received for the inclusion of accommodation for community care services for the Letterkenny area as part of the hospital develo~ment and the Department of Health deferred consideration of the stage 3 plans for the hospital until the planning brief for the community care accommodation was complete. The brief was completed and submitted to the department in May 1984. MATERNITY 95% of births in the North Western Health Board area took place in the obstetric units of Sligo and Letterkenny General Hospitals. The district hospitals are still used to a great extent for post natal care, but because planned referrals for delivery in the district hospitals have practically ceased it has been possible to re-assign some beds to other service needs. This development is in accordance with the policy on maternity services adopted by the Board in 1978 that on completion of the proposed extensions to the maternity units at both General Hospitals deliveries at the smaller units should cease but that facilities should be retained.

With approximately 4,000 births taking place annually in the area administered to by the North Western Health Board the task of collection,

10 analysis and reporting of personal information, manually, was prohibitive. Arrangements have been worked out with the consultants rnvolved for the collection and computerization of key data. The objectives of the perinatal statistics system is to provide the information In such a format as to allow those concerned to see the relevant correlations involved e.g. the correlations between an Infant's death and any number of factors (smoking, alcohol, drug, Ill health in mother, socio-economic group) .'

RENAL DIALYSIS Arrangements have been finalised for t he establishm~nt of a maintenance dialysis unit in a building at Sligo General Hospital. The equipment has been purchased, the staff trained and alterations necessary in the building are expected to be completed to allow the service to commence in July 1 984. Similar preparations are being made in Letterkenny General Hospital where the service is expected to commence later in the year.

RHEUMATOLOGY A Consultant Rheumatologist took up duty in the Regional Rheumatology Department at Our Lady's Hospital, Manorhamilton in July 1983. Since then the service has been developing steadily. Initially the service has been concerned mainly with the management of a wide range of arthritic conditions and collagen disorders. Twenty beds are operational at Our Lady's hospital and the Consultant holds clinics there as well as at Sligo and Letterkenny. A combined Rheumatology/Orthopaedic clinic has been established at Manorhamilton and is already proving to be of benefit to patients handicapped with crippling inflammatory joint disorders.

A major development of facilities at Our Lady's Hospital is now at architectural design stage. The developments planned include a new expanded physiotherapy departmem eomplete with hydrotherapy facilities, improvements in the occupational therapy, out-patients and other departments and the provision of day hospital and health centre facilities. Work on the scheme should start during 1984, early 1985.

GENERAL MEDICINE The opening of the new medical department in Letterkenny General Hospital in October 1 983 enabled the hospital to absorb the 7% increase in admissions without increasing the average bed occupancy. The overcrowding in the medical department of Sligo General Hospital continued at a similiar level to the previous year. lt is obvious at this stage that the investigation unit opened in 1 980 which was expected to relieve the overcrowding problem, has had little or no impact and will have to be reviewed.

ACCIDENT AND EMERGENCY SERVICE There was a drop of 30% in attendances at the Accident and Emergency departments in Sligo and Letterkenny General Hospitals following the introduction of the 'casualty fee' in 1982. However, the numb~rs attending these departments have increased steadily during 1983 and they are now almost at the level they were at prior to the introduction of the charge.

Average montty attendances prior to introduction of charge on 1/9/82: 3,066 Average monthly attendances for 6 months after introduction of charge: 2,145

11 The Standing Committee on General Hospitals at its May 1984 meeting unanimously agreed that the charge be increased to £1 0 for the first attendance and £5 for each subsequent attendance. The persons liable for the charge would be those who could appropriately be dealt with by a G.P. and would exclude the following:-

- Medical Card Holders - Children - Genuine Accident and Emergency Cases.

AMBULANCE AND TRANSPORT SERVICES The Board operates a fleet of 37 vehicles located throughout the North Western Health Board Area. During 1983 the Board's Ambulances answered 1 2, 7 63 calls - an increase of 91 0 on the previous year. ' Radio telecommunications in west Donegal were greatly improved in 1983 with the opening of the repeater site situated at Meencross, Dungloe. A further 4 ambulances were purchased during the year at a cost of £80,000.

There are four major services requiring transport of ambulant patients and it is the policy of the Board to operate transport to out-patient clinics, day hospitals, and training centres through car hire. The Service charge for car hire transport to out patient clinics implemented in 1982 has allowed the Board to continue the service in spite of financial cutbacks. The mileage for care hire services was up 260, 000 on the previous year.

GENERAL MEDICINE Patient Throughput Ave. Duration of % Bed Occupancy HOSPITAL Dec. '81 Dec. '82 Dec. '83 Var. Dec. '81 Dec. '83 Dec. '84 Dec. '81 Dec. '82 Dec. '83 Sligo 2566 2780 2888 (+4%) 9.7 7.6 7.4 124% 105% 107% 2538 2725 (+ 7%) 6.9 6.8 87% 90% 81%

GENERAL SURGERY

Patient Throughput Ave. Duration of Stay %Bed Occupancy HOSPITAL Dec. '81 Dec. '82 Dec. '83 Var. Dec. '81 Dec. '82 Dec. '83 Dec. '81 Dec. '82 Dec. '83 3387 3149 3253 (+3%) 6.5 6.4. 6.5 87% 86% 84%

12 MATERNITY

Patient Ave. Duration of HOSPITAL Dec. '81 Dec. '82 Dec. '83 Var. Dec. '81 Dec. '82 Dec. '83 Dec. '81 Dec. '82 Dec. '83 1867 1913 1821 (- 5%) 6.0 5.9 5.7 102% 98% 95% 2430 2251 2438 (+8%) 5.5 5.2 73% 68% 69%

GYNAECOLOGY

Patient Throughput Ave. Duration of Stay o/o Bed Occupancy HOSPITAL Dec. '81 Dec. '82 Dec. '83 Var. Dec. '81 Dec. '82 Dec. '83 Dec. '81 Dec. '82 Dec. '83 790 700 741 + 6% 6.2 6.4 5.8 96% 88% 84% 1245 1255

PAEDIATRICS Patient Throughput Ave. Duration of Stay % Bed Occupancy HOSPITAL Dec. '81 Dec. '82 Dec. '83 Var. Dec. '81 Dec. '82 Dec. '83 Dec. '81 Dec. '82 Dec. '83 1798 1629 1922 (+ 18%) 6.3 6.2 5.6 91% 81 o/o 88% letterkenny

OPHTHALMOLOGY Patient Throughput Ave. Duration of Stay HOSPITAL Dec. '81 Dec. '82 Dec. '83

INVESTIGATION UNIT Patient Ave. Duration of Stay % Bed Occup~ncy HOSPITAL Dec. '81 Dec. '82 Dec. '83 Var. Dec. '81 Dec. '82 Dec. '83 Dec. '81 Dec. '82 Dec. '83

13 INTENSIVE CARE UNITS Patient Ave. Duration of Stay % Bed Occupancy HOSPITAL Dec. '81 Dec. '82 Dec. '83 Var. Dec. '81 Dec. '82 Dec. '83 Dec. '81 Dec. '82 Dec. '83 220 210 220 + 5% 4.0 4.4 3.9 81% 85% 78% letterkenny 300 297 -1% 3.0 3.5 81% 83% 72%

E.N.T.

Patient Throughput Ave. Duration of Stay % Bed Occupancy HOSPITAL Dec. '81 Dec. '82 Dec. '83 Var. Dec. '81 Dec. '82 Dec. '83 Dec. '81 Dec. '82 Dec. '83 Sligo 1120 1149 1092 - 5% 4.9 4.9 4.9 109% 111 % 105% Letteri

ORTHOPAEDICS Patient Ave. Duration of Dec. '81 Dec. '82 Dec. '83

DISTRICT HOSPITALS

Patient Throughput Ave. Duration of Stay %Bed Occupancy Hospital Dec. '81 Dec. '82 Dec. '83 Dec. '81 Dec. '82 Dec. '83 Dec. '81 Dec. '82 Dec. '83 Ballyshannon 669 646 634 22.9 23.2 23.8 76% 75% 75% Carndonagh 579 491 549 19.2 22.4 21 .2 76% 75% 71 % 750 688 718 13.7 14.7 14.2 97% 96% 96% Dungloe 1123 981 1030 11.8 12.5 12.6 74% 69% 72% Ufford 660 613 642 19.9 21.4 22.1 75% 75% 81 o/o

14 The recent trends of decreasing patient throughput at the Boards district hospitals was halted in 1984 as 4 of the 5 hospitals increased their turnover on the previous year. The more active role of the district hospitals in the provision of "short stay" hospital care is highlighted by the average length of stay which,apart from the wide variations between individual hospitals,are still considerably lower than the national average. In fulfilling its supportive role to the general hospitals each district hospital provides services for convalescent patients transferred from the general hospitals in the Boards area and from hospitals outside the Board's area.

Though admissions had fallen in 1 982, bed occupancy remained at the 1 981 level because of long periods of hospitalization by a considerable number of patients who no longer required acute treatment. Steps were taken in 1983 to alleviate the situation through better utilization of the social work service and the designation of some beds in each hospital for long-stay patients. Another measure which has been instrumental in curbing the number of social admissions to district hospitals is the development over the past 10 years of fully serviced day hospital facilities at each hospital. lt is acknowledged t'lat the availability of this service has reduced demand for in-patient treatment, reduced duration of stay of patients admitted to hospital and is of primary importance in creating patient activation and rehabilitation.

DAY HOSPITAL SERVICES The overall purpose of the day hospitals is to provide adequate care within the community as close as possible to where the patient lives. Its primary benefit is to enable people to be maintained in the community by providing a wide range of services at the hospital which can be availed of according to the needs of the patient, by attending on a regular basis. Experience has shown that the availability of day facilities can reduce the demand for in-patient treatment, can reduce the duration of stay of patients admitted to hospital and,of primary importance,)ncrease patient activation thus allowing them to play more active roles.

The range of services currently available at the 1 2 centres in the North Western Health Board region include Medical, Nursing,Physiotherapy, Occupational Therapy, Chiropody and Social Services incorporating meals, baths and laundry. In addition to this( consultants from the acute general hospitals who hold regular clinics at the various locations made themselves available to the day hospitals as required.

To date the emphasis has been placed on the development of these services based on existing hospitals and in accordance with Board policy day hospital services have been provided at all of the district and geriatric hospitals. Full use is made of the existing hospital and community care services at each location which ensures that the day hospital has an integrated flexible network of facilities to cater for the varying needs of the local community. Similar services have been developed in recent years at the community nursing units - the latest being that provided at Buncrana in 1983. A new day hospital will oj:.en shortly in St. Calumba's Hospital catering for 1 5 to 20 patients. The Board will continue to further develop day hospitals as an alternative to in-patient services and also as a means of shortening hospital stay by maintaining hospital services to the patient after discharge on a day time basis. The day hospitals. currently in operation are as follows:-

CARRICK-ON-SHANNON This day hospital is located at St. Patrick Hospital, Carrick-on-Shannon. lt was the first hospital to operate in this health board area ( 1 9 71 ) and the

15 level of aervlce ha1 increaaed greatly 1lnce then. The extenalon provided In 1978 allow• patlentl to be aegregated Into grouping• ap-propriate to the 1ervlce1 being availed of and allows the various dl1clpllnea to work In Independence. lt caters for mo1t part• of south Leitrim, while 1 number of patients from north Roscommon also attend. At present there are 178 persons .who attend on a regular basis.

ITRANORLAR located at St. Joseph'1 Ho1pltal, Stranorlar this day hospital caters for Stranorlar, Cloghan, letterkenny, Killygordon and parts of Castlefln and Churchill. lt currently provides services for 87 persons who attend regularly. The day hospital has recently been transferred to 1 free &tending building on the hospital grounds. This building was reconstructed for the purpose, and the transfer of the day hospital from the ground floor of St. Joseph's will facilitate the development of day hospital services there.

IUGO The majority of people on the register of this day hospital are residents of Sligo or live within a reasonable distance of the town. Quite a number of the 76 persons who use the service utilize the day care/social services alone. Some of the patients attend twice or three times a week though most come at least once per week.

UFFORD This unit commenced operation in 1974 in a free standing prefabricated building. In common with all day hospitals patients are referred by their local ~ general practitioners or public health-nurses and having been assessed are referred for medical, nursing or para-medical services appropriate to their needs. Lifford day hospital services the catchment area of Burt, Killygordon, Newtowncunningh.am and Raphoe with an average daily intake of 1 5 to 20 patients - there are 2 7 8 persons on the register.

DONEGAL Day Hospital services commenced in Donegal Day Hospital in 1977 in improvised accommodation. The present unit was opened in 1982 and consists of a day room, occupational therapy room, dining room, office, bathroom with medi-bath and reception area. The unit services the · catchment area of Killybegs, Ardara, Glenties, Barnesmore and Laghey. In common with many day hospitals.patients are-brought in at regular intervals (usually once per week) by residential area. This enhances the social aspect of the service as it gives the elderly an opportunity to meet their friends and neigh_bours. Altogether 115 persons use the tacility on a regular oas1s.

16 The Dsy Hospital st Donegal District Hospital.

17 CARNDONAGH Carndonagh was one of the first hospitals in the region to be provided with a purpose built day hospital unit which opened in 1979. The unit contains facilities for physiotherapy, occupational therapy, medical, nursing, bathing an9 has a very domestic type day room. Attendances at the unit increased very rapidly because until recently it was the only day hospital in the lnishowen area. Since day services commenced in Buncrana in 1983 the number of persons on the Carndonagh register has halved to its present level of 76 while attendances were high at 3,043 during 1983.

BALL YSHANNON Day Hospital services at the Sheil commenced in 1978. A new day hospital was built in 1 980 with facilities to cater for both Day Hospital and Day Care patients. This unit caters for an average of 1 2 to 1 5 l)atients per day from a catchment area which includes Laghey, Pettigo, Kinlough, Rossnowlagh, Bundoran and Ballintra. There are currently 228 persons on the register for this unit.

LETTERKENNY This unit caters for an average of 1 5 attendances per day (all former-in­ patients), the majority of whom avail of training in the occupational therapy, industrial therapy departments and horticultural areas of St. Conal's Hospital.

In addition to the afore mentioned, fully serviced facilities are provided at the community nursing units in Falcarragh, Ramelton and Buncrana. Limited services are also provided in Mohill.

Despite the financial constraints of recent years the Board has continued to develop the day hospital service. They have only been closed during staff holiday periods. The average cost per patient visit at any of the Boards day hospitals is £12.50 made up as follows - Staffing costs per patient visit £8, Transport per patient visit £ 1 . 50 and Food/Bath/Laundry per patient visit £3.00. Total attendances in 1983 exceeded the 40,000 mark for the first time with over 1,600 people utilizing the service on a regular basis.

Where practicable all transport requirements (clinics, admissions, day nospitals etc.) are co-ordinated, but it is necessary to provide specific transport to most of the day hospital units. This day hospital utilizes its own minibus for the majority of attendances and hired transport is used for the remainder.

DUNGLOE The Day Hospital in Dungloe opened in 1977 though the present purpose built accommodation was provided in 1980. A small x-ray unit was also incorporated i.1 this development. The day hospital serves a catchment area of Fintown, LE:ttermacaward, Glenties, Dungloe, Kincasslagh, Mulladuff, Annagry, Ranafast and Loughanure. All patients are transported in the hospital's own minibus and the average daily intake is 12 patients.

18 - "Day Hospital Services at Dungloe District Hospital, Co. Donegal" 19 COMMUNITY PSYCHIATRY The standing committee on special hospitals visited each of the psychiatric and geriatric hospitals and examined the services provided in each location. During the year, the committee considered arrangements and developments in the following areas :-

Community Psychiatric Nursing Social Club, Stranorlar Alternative Housing for Long-Stay Patients Psychological Service, Letterkenny Rehabilitation Services Development of Services for Aged Capital Development Schemes Alcoholism Child Psychiatric Services Hospital Farms Any programme aimed at providing a comprehensive psychiatric service for the population it serves must place major emphasis on developing the services at community level rather than the traditional institutional service. The services which have been established in the catchment areas of both psychiatric hospitals in recent years include the appointment of community psychiatric nurses of which there are a total of fourteen, day hospitals, day care centres, hostels, group homes, workshops, out - patient clinics, etc. The area south of the Laghey/Pettigo line (catchment of St. Calumba's Hospital) was divided into 4 districts with each consultant having the responsibility of providing a consultant psychiatric in-patient/out-patient service for the patients in his/her district. The area is divided as follows: -

1. North East Sligo, South Donegal and Y.. of Sligo Town. 2. South Leitrim and Y.. of Sligo Town. 3. North Leitrim, North West Sligo and Y.. of Sligo Town. 4. South Sligo and Y.. of Sligo Town.

Similarly the area north of the Laghey/Pettigo line (catchment area of St. Canal's Hospital) was divided into 5 districts with consultants responsible for the development of community services for the following areas: - 1 . South Donegal, South West Donegal. 2. Mid Donegal, West Donegal. 3. North West Donegal. 4. lnishowen Peninsula. 5. North Donegal, East Donegal.

Multidisciplinary psychiatric community teams operating in each district comprise of the consultant psychiatrist, the community psychiatric nurse(s), psychiatric social worker, and the clinical psychologist. With the development of this team structure,_psychiatric care and treatment and counselling facilities have been carried from the institutional setting of the psychiatric hospitals to the community through the use of community clinics, home visits, and contacts in hospitals, welfare homes, health centres etc. Cases are assigned on the basis of needs of the patients and the skills available. Sometimes all disciplines will be involved in a case, though the majority of cases are taken by the community psychiatric nurses. Close links are maintained with primary care teams in each district,particularly the general practitioners and the public health nurses.

Each district has an average population of 25,000 people and with an ideal establishment of one community psychiatric nurse to every 10,000 people there should be on average 2 nurses in each district. However,

20 although the Board intends in the future to create a total of 21 posts, the 14 nurses working in the community (6 in the catchment area of St. Calumba's, 8 in the catchment area of St. Canal's) must continue to improve the service despite the large catchment areas and consequent workloads.

The points of contact other than patients homes in each district are as follows:

South Leitrim Oinic Centres C.P.N. Basef H9SJ)itals Day HospitaVDay Centre

Drumshanbo Drumkeeran Ck-<>n-Shannon Carrick~n-Shannon Carrick-on-Shannon Mohill

North Leitrim, North West Sligo Oinic Centres C.P.N. Bases Hospitals Day Hospital/Health Centre Manorhamilton Dromahaire Manorhamilton Drumkeeran Easkey Sligo Sligo Enniscrone

South Donegal, North East Sligo Clinic Centres C.P.N. Bases Hospitals Day Hospital/Health Centre Ballyshannon Ballyshannon Ballyshannon

South Clinic Centres C.P.N. Bases Hospitals Day Hospital/Health Centre

Tubbercurry Tuboorcurry~ ______R_i_ve_r_~ _o_w_n______Gurteen

21 South Oinic Centres C.P.N. Bases Hospitals Day Hospital/Health Centre Donegal Donegal Donegal Donegal Stranortar Ballybofey Ballybofey

Mid Donegal, West Donegal. Clinic Centre C.P.N. Bases Hospitals Day Hospital/Health Centre Dungloe Dungloe

North West Donegal. Clinic Centre C.P.N. Bases Hospitals Day Hospital/Health Centre Falcarragh

lnishowen Peninsula Clinic Centre C.P.N. Bases Hospitals Day Hospital/Health Centre Buncrana Buncrana Carndonagh Camdonagh Camdonagh

North Donegal, East Donegal Clinic Centre C.P.N. Bases Hospitals Day Hospital/Health Centre

22 Community Care COMMUNITY CARE PROGRAMME INTRODUCTION This report is divided into the following sections : 1. Resource allocation to Community Care 1983. 2. Policy on Community Care Services. 3. Major Developments in Community Care Services - 1983. 4. Selective review of some professional services. RESOURCE ALLOCA T10N The Board's total allocation for direct expenditure in 1983 was £58.1 million representing a cut of·£ 1 million over that required to maintain services at 1982 levels. In planning the allocation of resources between services the Department of Health asked that the allocation to Community Care should reflect a clear priority for Community Services and should fully recognise the role of the voluntary sector. The allocation for direct expenditure of 1 7. 7 million to Community Care was estimated to maintain services at 1982 levels and to make specific improvements in selected areas where developments were taking place for the disabled, the homeless, deprived children and the aged. The underlying policy in relation to the Community Care programme for 1983 was to maintain and develop the Community Services as an alternative to institutional care. The development of preventive health services, the development of family support and community support services as well as the enhancement of the role of voluntary organisations were fundamental. In particular it was agreed that the services for the disabled developed in 1982 should be opened e.g. Sligo and Carrick-on-Shannon Day Care Units, that the dental and opthalmic schemes should be operated at the 1981 level, that the level of home-help services would be restored and the real value of grants to volu.ntary organisations would be maintained. The lifeskills project which was initially a pilot project was established on a permanent basis. POLICIES ON SERVICES REVIEWED BY THE BOARD. The Board reviewed the operation of and updated policies on the following services during 1983. The details are available in the~ individual reports listed hereunder. REPORT MONTH Resource Allocation January '83 Incidence and Treatment of Tuberculosis January '83

Capital Priorities Feburary '83 Housing Aid for Elderly March'83 Social Work Report March ' 83 Training Centres for Disabled April '83 Vaccination and Immunisation Services April '83 Day Care Services for Mentally Handicapped April ' 83 Home Help Services May '83 Drug Abuse May '83 Non Accidential Injury to Children June ' 83 Aids I Information Service to Disabled June '83 Implementation of Poisons Regulations June '83 Boarding Out of Children June '83 Public Analyst Laboratory Services July '83 Vocational Assessment Servies for Disabled July '83 General Medical Services Annual Report July '83 Public Health Nursing Services September ' 83 Alcoholism and Problem Drinking in Industry October '83 Drug Abuse and the Task Force Report October '83 Services to Travelling People November '83 Hostel Services for Disabled November '83 23 The reports and the recommendations contained in these reports to the Board were drafted following consultation and discussion with the Standing committee, Community Care. The work of the Committee greatly facilitated the development of policies and recommendations on the above services for the Board.

In addition to its eleven ordinary meetings the Standing Committee Community Care also had a special meeting to consider the report on Alcoholism and Problem Drinking in Industry. The Committee in fact, met members of Alcoholics Anonymous in the preparation of its report to the Board.

The committee also had two extraordinary meetings to consider draft submissions to various national committees. The following submissions were made to inter-departmental committees/task forces or commissions :

Submission to Task Force on Drug Abuse Submission to Commission on Social Welfare. Submission to National Youth Policy Committee. Submission to Inter-Departmental Committee on Marital Breakdown.

MAJOR DEVELOPMENTS IN COMMUNITY CARE SERVICES - 1983

SERVICES TO DISABLED The counselling services for the mentally and physically handicapped were further developed in 19B3. There were 13 new referals to the Counsellor in Sligo/leitrim and 12 new referrals in County Donegal in 1983. In addition to the comprehensive range of service's provided in 1982 parent support groups were established during 1 983, the toy library service was further developed in Buncrana and Donegal and the breakaway/home to home scheme was formulated for County Donegal. Because of the growing demand for the service a decision was taken to recruit two additional counsellors in the region.

The pre school/day care services were significantly developed during 1983. Services commenced from the new day care centre in Carrick-on­ Shannon in June '83 and in a new day centre in Sligo in July '83. The Board resolved at its July meeting to provide 100% funding to the Parents and Friends Association for both centres. The Board also funded the capital costs to the extent of 50%. A service commenced in temporary accommodation in Donegal town in conjunction with the local Parents and Friends Association. However, the construction of a purpose built day care/pre-school centre was at an advanced stage at the end of 1983. lt is hoped to have this building which is being funded jointly by the Board and the Donegal branch of the Parents and Friends Association commissioned by the second half of 1984.

The pre-school day care centre at Bal/ytivnan, Sligo, provided by the Parents & Friends Association with substantial funding assistance from the N. W. H. B.

24 The following numbers of children were attending day care/pre-school centres at the end of 1983 : TABLE 1. CHILDREN ATTENDING DAY CARE/PRE-SCHOOL CENTRES

CENTRE NO. ATTENDING Letterkenny 9 Dungloe 5 Donegal Town 4 Cloonamahon 12 8

The following facilities were opened in 1983 for the mentally handicapped :

Sligo Town - Hostel -to service Cloonamahon workshop. Dungloe - hostel to service day centre/workshop. Sligo Town - hostel to service Cregg House, Sligo.

Regional Unit for Emotionally Disturbed children, Cregg - plans were completed for this unit in 1983 and the contract was placed. The unit which will provide places for twenty four .emotionally disturbed children will be commissioned in late 1984.

Resitlential Unit, Stranorlar - This unit on the lower ground floor of St. Joseph's Hospital was opened in July 1983. The unit will cater for 30 mentally handicapped adults from the Donegal area.

At work, rest and play in the Residents/ Unit for the mentally handicapped which opened in Stranorlar, Co. Donegal during 1983

25 Vocational Assessment and training service - A site was acquired in Bundoran for this unit.

Vocational Training and Rehabilitation Services were expanded. In particular~ a sheltered workshop facility was opened at the day centre at Oungloe. A major extension to the workshop at Cloonamahon was carried out during 1983. There were 233 trainees in the Board's training centres at the end of 1983 as follows :

TABLE 2. NUMBER OF TRAINEES ATTENDING TRAINING CENTRES

CENTRES NO. ATTENDING Ballyraine, Letterkenny 57 Ballytivnan, Sligo 45 Gweedore 37

The physically handicapped records system was substantially compiled in Sligo/Leitrim in 1983. The need for a small residential unit for the physically disabled was established and various models were examined with a view to planning and commencing work on a unit in 1984 in Sligo Town. SERVICES TO THE ELDERLY Buncrana - A day service commenced at the Community Nursing Unit, Buncrana in conjunction with the Care of The Aged Committee. The service which commenced in July 1 983 caters for approximately 20 people two days per week. Approval was receivea to commission the C.N.U. in 1984 and it is proposed to open the unit in early August 1 984.

Work comme'"!ced on a 25 bed nursing unit in Ballymote in October 1983. The unit will replace the St. John of God Nursing home in Ballymote and it is expected that it will open in the last quarter of 1984.

Letterkenny - Work commenced on the building of a new day care centre in Letterkenny in mid 1983. The work is being undertaken in conjunction with the Letterkenny Social Service Council. The Council are building the unit on a site provided by the Board and with grant aid from the Board.

Arranmore - Work was almost completed at the end of 1983 on a Day Centre/Health Centre for the elderly on the Island. Annagry - Work was at an advanced stage at the end of 1983 on the provision of a day centre for the elderly in Annagry. The work which is being undertaken by the Care of The Aged Committee was grant aided by the Board.

Manorhamilton - A day care unit provided in conjunction with the nine Old Peoples Dwellings in Manorhamilton was officially opened in 1983.

The Housing Aid for the Elderly Scheme which commenced in 1 982 was continued in 1983. An allocation of £133,000 was made to the Scheme in 1983. A statistical profile of the scheme ( 1.12.1983) is set out hereunder in Table 3.

26 TABLE 3 HOUSING AID FOR ELDERLY SCHEME STATISTICAL INFORMATION AREA SLIGO PROJECTS DONEGAL LEITRIM 137 No. Approved 144 168 No. In Progress 44

A boarding out scheme for the elderly was devised and commenced in late 1 983 in County Donegal. The scheme which commenced on a small scale is a major new development in the approach to Community based services for the elderly. lt will be developed and monitored closely in 1984.

Major Review of Community Nursing Unit Programme - A major review was undertaken of the Board's plan for the development of C.N.U.'s in Donegal. The review incorp.orated the role of the District Hospitals and the impact of the development of the General Hospital and of the local authority Old Persons Dwellings in the County.

Following consultation with the voluntary committees in Tubbercurry a site was acquired in the town centre to accommodate the development of a health centre, day centre, nursing unit and non nursing residential services. A development plan for the site has been drawn up. Consultations took place with a religious order regarding the provision of nursing unit services in the town. SERVICES FOR CHILDREN Cashelgarron - Work on the renovation of the house at Cashelgarron, Sligo, for a family group home was completed in 1983. Plans for the development of residential services for children integrated with the overall provision of child care services were formulated before the end of the year. lt is intended to open Cashelgarron in mid 1984.

Letterkenny - The development of domiciliary care services. as recommended in the Task Force report,using the hostel in Letterkenny as a base for foster families, for problem children etc. was established in 1983. The service will be developed in 1 984 using the Family Group Home as a base.

Nazareth House, Sligo and Fahan - The changes recommended in the inter-departmental committee report on the organisation and funding of these homes was discussed in 1983. Plans for the integration of the services at these centres ;,.lto the child care services for the region were agreed by the end of 1983 and will be implemented in 1984.

Fostering and foster support services were further developed in 1983 and the Board approved increases in the capitation rates to foster families. A statistical profile of the numbers in residential and foster care at the end of 1983 is set out in the table hereunder.

TABLE 4

NUMBERS IN RESIDENTIAL AND FOSTER CARE IN 1983 DONEGAL SLIGO/LEITRIM No. In Residential Care 39 32

27 The summer project for socially deprived and handicapped children was further expended in 1983.

The child health services, speech therapy, psychology and dental services to children were maintained and developed during 1 983. The details of services provided by these professionals are set out in the review of profe.ssiof)al services· in particular the child health services were reviewe~ in detail in a report to the Board in February 1984 on Area Medical Officers Services.

SERVICES FOR HOMELESS Hostel Sligo - work was, completed on a hostel for the homeless at Ballytivnan, Sligo in 1983. The service commenced in the last quarter of 1983. The service is beir.g run at little or no cost to the Board because of an extraordinary participation from volunteers to man the service at night. A total of 90 volunteers participate in manning this service on a rota basis. The average attendance was in the region of 1 30 bed nights per month with a maximum number of. 1 0 using the service in one night. The majority of clients using the service stay less than 4 nights in succession. The co­ operation of local residents in relation to the establishment of the service should be recognised. In the other areas of the region provision was made through the C.W.O. services for shelter and maintenance for homeless persons.

External and internal views of the hospital for the homeless, which came into service towards the end of 1983, at Ballytivnan, Sligo

28 SERVICES TO SINGLE PARENTS The Mother and Baby home in the Castle, Newtowncunningham completed its first year of operation in 19B3. The numbers availing of the service are set out in Table 5 hereunder. The services provided to single parents by the Social Work department were expanded through the re-deployment of existing staff. TABLE 5. NUMBER ATTENDING MOTHER AND BABY HOME PLACE OF ORIGIN DECISION ON CHILD Co. Donegal B Adoption 11 N. Ireland 13 Keeping Child 15 Other Areas 7 Total 28 *26 (*Two died)

SERVICES TO FINANCIALLY DISADVANTAGE/SOCIALLY DEPRIVED Income maintenance services provided by the Board are administered mainly through the Community Welfare Officer service. In addition family support services for the financially disadvantaged and the socially deprived are provided also by the social work, home help, public health nursing and other paramedical support services. These services were maintained and developed in 1983 in line with the general policy of developing the Community Care services as an alternative to other forms of care. The average number of weekly recipients of basic Supplementary Welfare Allowance in 1983 was 475 in Donegal and 327 in Sligo/Leitrim. This represented an increase of over 1 0% in the average number of weekly receipients over the corresponding figure in 1982. The number of receipient'f' of Single Exceptional Needs payments in 1983 was 1 ,316 in Donegal and 405 in Sligo/Leitrim. This represented an increase of 29% over the corresponding figures for 1982. These sharp increases in demand for income maintenance services seem to reflect rising unemployment, rising prices combined with the inadequacy of Social Welfare Payments to meet the basic needs of families.

"the-Community work services and services provided by voluntary organisations to financially and socially deprived families were further developed in 1 983. Priming grants to the following community pre-school groups were made in 1983 : Donegal Town Community Playgroup St. Johnston Ball intra Ballybofey Bundoran Porthall Ardara Lifford Tubbercurry St. John's Sligo The services provided by these groups are mainly available for deprived children. The community workers also worked with various community groups and the Board made available grants towards the provision of community centres in Sligo (St. Joseph's/Brigid's- £11 ,000) and Dromore West (£5,000). A grant was made for the St. Anne's Youth Project in Sligo which is mainly geared to provide family and community support services for children and adolescents. Financial assistance and community work support services were a1so provided to the Irish Society for the Prevention of Cruelty to Children for the project in Wolfe Tone Street, Sligo which is mainly for socially deprived children. 29 PREVENTIVE HEALTH SERVICES . Apart from the maintenance of our existing range of preventive health services provided through the Area Medical Officers, Public Health Nurses, Social Workers and other Paramedical and Health Education Staff the major developments were in the area of the Lifeskills Programme in Second Level Schools and the Mother and Infant Welfare Programme.

The Lifeskills programme which was established on a pilot basis in 1981 / 1982 was established on a permanent basis in 1983. A project manager for the programme was appointed together with a teacher, development officer and secretarial support. Accommodation for the project was leased in Donegal Jown and a Library seniice and other material support services to second level schools was established. The programme was extended into 25 Second Level Schools. A statistical profile of the Lifeskills Programme is set out in Table 6 below. TABLE 6 . LIFESKILLS PROGRAMME IN SECOND LEVEL SCHOOLS No. of Schools Partici 25 Total enrollment in these schools 11 ,826 Lifeskills programme was delivered to and represents 46% of the total student population w ithin these schools

The Mother and Infant Welfare Programme was further developed through the establishment of two posts of Health Education Nurses at Sligo General Hospital and in the Community Care programme. A comprehensive ante-natal and post-natal education, advisory and instruction service will be provided by these nurses and also of course through the medical, nursing and other paramedical staff involved in the provision of services to Mothers and Infants. In Donegal the programme was developed mainly through the provision of ante-natal classes by Public Health Nurses and General Practitioners in various centres throughout the county.

PUBLIC INFORMATION AND ADVISORY SERVICE The development of this service, which was established at almost 100 centres throughout the region was a major project in 1983. lt involved the drafting, design and printing of a comprehensive set of information leaflets. lt involved the training of various grades of staff in providing information, advise or assistance to the public in relation to all health and welfare services. lt also involved the design and making of display stands. Nearly all of this latter work, including also the printing work, was undertaken in the Board's workshops for the disabled.

MANAGEMENT SERVICES Budgetary Contrpl Systems and activity reporting systems were further developed in 1983. The first full years operation of the responsibility reporting system was completed in 1983. The system divides the total expenditure of the Community Care programme between individual heads of services who are responsible for controlling budget, for monitoring the efficiency of expenditure and for optimising the use of resources. The activity reporting system provides each Senior with information on the activity levels for each aspect of the service and for the services provided to each target group in the programme. lt allows for better control of service levels, for more efficient deployment of staff and resources and for controlling unit costs.

30 ADMINISTRATIVE SERVICES The administrative services in Community Care received very little publicity. In fact in times of cut back these services are the first to attract attention and sometimes criticism. To some extent this may be due to the fact that the Board has not provided sufficient public information on the services provided by administrative staff. lt is sometimes though that these services do not !lave a direct bearing on the standard of health and welfare services which is provided to the public.

In fact an examination of the range of services provided by the administrative staff will clearly indicate that these services have a direct bearing on the standard of care and the allowances provided to individual members of the public. The range of services include the following-:-

(a) Allowances and Services such as D.P.M.A., Mobility Allowance, Maternity Cash Grants, Domiciliary Care Allowances, Blind Welfare Allowances, Allowances for boarding out of children and the elderly, Rehabilitation training, transport and maintenance allowance. Othe,r services include assistance towards the cost of drugs, long term illness schemes and financial assessment of eligibility for home help, meals, laundry and other care of the aged services.

(b) Opthalmic services provided through the choice of Optician Scheme_

(c) Capitation payments made to residential units in respect of physically handicapped adults and children and to a number of elderly nursing units.

(d) " Maternity Cash Grants and payments to general practitioners for services provided to persons in Category 1 eligibility. (e) Administration of Housing Aid for the Elderly Scheme. (f) Administration of Section 65 grants to voluntary bodies and liaison with voluntary organisations in the region inci•Jding a large number of meetings at unsocial hours e_g, nights and weekends.

(g) Maintenance works and improvements (h) Administrative support to Nursing Units and Welfare Homes. In fact the major developments outlined in this Annual Report to the Board involved the administrative staff in the two Community Care areas in work outside of the normal routine administrative work and involved a lot of liaison with architects, contractors and solicitors.

The following statistical profile of the administrative activities in tne Community Care Area, Sligo will give some indication of the nature, type and level of Administrative services provided in 1983.

TABLE 7

COMMUNITY CARE SLIGO - ADMINISTRATIVE ACTIVITIES 1983

LONG TERM ILLNESS No. of applications received 67 No. of applications approved 48 No. of applications refused 19

No_ of of booklets in circulation at Decernber, 1983 367

3 1 DRUGS REFUND SCHEME No: of claims received 3255 No. of claims paid 2978 No. of claims refused (no refund due) 277

SPECIAL TYPE CONSULTATIONS No. processed 1678

CHOICE OF OPTHALMIC SCHEME No. of applications received 868 No. of applications approved 842 No. of applications refused 26

INFECTIOUS DESEASES ALLOWANCES No. of applications received 3 No. of applications approved 3 No. on allowance at 31 / 12/83 3

MOBILITY ALLOWANCE No. of applications received 4 No. of applications approved 4 No. in receipt of allowance at 31/12/83 20

DISABLED PERSONS MAINTENANCE ALLOWANCE No. of applications received 111 No. of applications approved 63 No. of applications rejected 48 No. in receipt of allowance at 31 / 12/83 386

DOMICILIARY CARE ALLOWANCE No. in receipt of alloance at 31 / 1 2/83 70

MATERNITY SERVICES No. of applications received 801 No. of applications approved 765 No. of applications refused 12 No. of applications being processed 24

MATERNITY CASH GRANTS No. of applications received 65 No. of applications approved 58 No. of applications rejected 2 No. of applications pending 5

BLIND WELFARE ALLOWANCE No. of applications received 1 Total number in receipt of allowance 31 / 12/83 20

32 HOME HELP No. of applications received 179 No. of applications approved 147 No. of applications rejected 13 No. of applications pending 6

MEALS No. of applications received 24 No. of applications approved 13 No. of applications rejected 1 No. of applications pending discision 10

LAUNDRY No. of applications received 62 No. of applications approved 44 No. of applications rejected 15 No. of applications pending i5

MEDICAL CARDS New applications received 1956 New applications approved 1449 New applications rejected 103 New applications pending 404

No. of reviews issued 2176 No. of reviews withdrawn- ineligible 275 No. of reviews withdrawn - other reasons 1197

SUMMARY Total number of decisions taken on applications 5,664 Total number of payments made (approx) 12,500 Total number of orders written 750 SELECTED REVIEW OF SERVICES In line with the approach adopted in last years Annual Report it is proposed to review a number of the professional services in the Community Care Programme. As the social work, public health nursing and home help services were reviewed comprehensively in 1983 in separate reports to the Board it is not intended to further review them in the Annual Report. In addition a comprehensive report on the Area Medical Officer service was presented to the Board in Februray 1984 and this contains all the relevant information in relation to this service for 1983. This year the Speech Therapy, Health Inspectorate, General Medical Services, Dental Services Donegal and Administrative Services, Sligo are reviewed.

SPEECH THERAPY SERVICES. Slgo/Leltrlm The staff complement for Speech Therapists in Sligo/Leitrim Is as follows: 1 Senior Speech Therapist 4 Basic Grade Speech Therapists The main basis for the services are at Cleveragh Road, Sligo and Leitrim Road, Carrick-on-Shannon. The numbers attending therapy services are as follows :

33 Regular attenders 233 Review cases 121

The number of attendances and non-attendances at each clinic held in 1 983 are as follows :

T~8 CUNIC . NO. ATIENOING O.N.A.% NO. NON ATIENOANCE Clewragh Road 1,321 203 15.36% Ma1

~School 36 School. 197 174 10

34 The breakdown of presenting disorders is set out in Table 9 TABLE 9 PRESENTING DISORDERS % OF WORKLOAD DELAYED SPEECH AND LANGUAGE DEVELOPMENT Secondary to Developmental Delay/Environmental factors. 28.21 % Secondary to Mental Handicap 16.98% Secondary to Hearing Loss 1.64 % DYSARTHRIA -articulation disorder affecting respiration, phonation and articulation caused by brain injury, i.e. stroke, road traffic 3.56% accident. Cerebral Palsy. DYSPHASIA - Language disorder caused by brain injury, i.e. road traffic accident, stroke. 2.46% ARTICULATION DISORDER - Secondary to oral abnormalities i.e. cleft plate. 3.83% PHONOLOGICAL DISORDER 25.20% DEVELOPMENTAL DYSPRAXIA 1.09% VOICE DISORDERS - including laryngectomees i.e. patients who have had their larynx's removed. 4.38% CHILDHOOD D YSFLUENCY 3.01% STA MMER 5.47% SPECIFIC LANGUAGE DISORDER 1.36%

COMMENTS There is a particularly high non-attendance rate in Leitrim especially in Mohill where the percentage is 51.87%. The high percentage of non­ attendance may be due to the fact that parents are not aware of the importance of therapy, that transport facilities are poor in some cases and that some parents think it does not matter if they miss some clinics.

The main source of referrals are public health nurse (30%), A.M.O.'s ( 19%), G.P.'s ( 16%), Consultants ( 1 5%), Psychologists (4%) and parents (5%).

As mentioned in the review o.f service to the physically disabled there is a speech therapy service provided to this group. At present there are 16 physically handicapped children attending speech therapy clinics in the Sligo/Leitrim area - 7 of these have associated mental handicap.

Speech Therapy Services - Donegal The complement of Speech Therapists in Donegal is as follows :

Principal Speech Therapists 1 Senior Speech Therapists 4 Basic Grade - Speech Therapists 3

35 The clinics services in Donegal and the number attending are set out in the following table :

BASE CLINIC REG. CURRENT CASES REVIEW WAITING LIST Buncrana 104 88 30 59 98 62 25 32 6 Letterkenny 108 116 34

The number of attendances and non-attendances at each clinic in the district clinics held in 1983 are as follows : TABLE 10

CLINIC NO. ATTENDING D.N.A. %NON ATTENDANCES Buncrana 2,945 433 14.71% Donegal 520 78 15% Dungloe 210 35 16.46% Letterkenny 2,796 434 15.51% General Hospital 78 31 40% Grand Total

In each of the A.M.O. districts mentioned above a fairly comprehensive service is provided. In the Buncrana area it includes the special class for the mildly mentally handicapped girls in Carndonagh, the James Connolly Memorial Unit and Raphoe Health Centre. In Donegal area it includes the health clinic, St. Agnes Special class, St. Agnes Day Centre, Ballintra, Carrick and Glenties. In Dungloe it includes the special classes for the mentally handicapped and in Letterkenny the Day Care Centre, St Bernadette's School, General Hospital and St. Joseph's Stranorlar.

Among the issues of concern in Donegal are that only 21 % of the current case load are pre-school children. The need for early referral is all important if a speech and/or language disordered individual is to achieve his/her potential.

36 An analysis of the case load for County Donegal is set out in Table 11 hereunder :

TABLE 11 DISORDER PERCENT AGE OF CASELOAD. 1 . Pre-School speech and/or language disorder 10.94% 2. School Age speech and/or language disorder 13.43% 3. Young strokes/head injury patients 1.20% 4 . Pre-School physically handicapped 8.75% 5. Pre-School mentally handicapped 2 .54% 6. Adult (Stranorlarl 1.18% 7. larnagectory 0.07% 8. Articulation Only 12.03% 9. School age Mentally Handicapped 21.82% 10 . School age Physically Handicapped 7.53% 11 . Stroke-Patients 50-60 + 12.30% 12. School age Stamerer 4.24% 13. Voice 1.19% 1 4 . Partial hearing 1.00% 1 5. Adult Physically Handicapped 0.18% 1 6. Adult Mentally Handicapped 1.54% 1 7. Psychiatric Patients

The speech therapy service is a comparitevly new community care service. lt has been encouraging to see its development during 1983. There are still problems to be resolved to in ensure a high level of publiCfl awareness, in ensuring that priorty cases come to the attention of the speech therapists and i'n ensuring that accommodation, equipment and refresher training is provided.

HEALTH INSPECTORATE SERVICES The complement of Health Inspectorate personnel in the region is as follows: DONEGAL SLIGO/LEITRIM

1. Supervising Health Inspector 1. Supervising Health Inspector

2. Senior Health Inspectors 2. Senior Health Inspectors

6. District Health Inspectors 6. District Health Inspectors

The duties of the Health Inspector are very extensive covering statutory responsibilites on behalf of the Health Board and local Authority. The duties can be broadly identified under five main headings -

Food control Planning Housing Environmental Services Health Education

In the past concern was expressed that the Health Board duties were not being performed. lt is gratifying to note that the situation has been changing with the improvement in the complement of Health Inspectors. The equivalent of at least 3 full time inspectors has been given to Health Board duties in both community care areas in 1983.

37 TABLE 12 NO. OF INSPECTIONS DESCRIPTION DONEGAL SLIGO/ LEITRIM Hotels 142 172 Restaurants 460 177 Butcher Shops 200 206 Bakeries 84 30 Fish processing Plants/Fish Monger/Shellfish 30 36 Food Wholesalers/Manufacturers 23 37 Food Vehicles and Food Stalls 47 Licensed Premises 810 Canteens 8 Retail food Premises/Poulters 30 781 Applications for Registration 17 Investigation of Food Complaints 16 Food and Drug samples 147 240 Informal Notices Served 8 Rodent Control 19 49 I.H.C.I. Lectures 25 School Inspections 6 163 Poisons Regulations 99 60 Milk and Dairies Inspections 22 106 Water Samples 740 2,342 Fluoridation Sampling 72 78 Planning and Development Inspection 2,897 345 Temporary Dwellings 174 16 Housing Inspections 2,835 1,657 Slaughter House Inspections 154 96 Dancehalls 46 24 Drainage and Effluent 342 28 Public Health Nuisances 47 116 Swimming Pools 23 Hospitals 8 17 Beach Inspections 76 Refuse Dump Inspections 71 26 Burial Ground Inspections 34 Atmospheric Pollution 13 Caravan site inspections 174

Some comments on the operation of the Health Inspectorate Services in 1983 are worth mentioning.

The emphasis on Health Board duties has resulted in an increased level of inspections of all food premises subject to Article 2 5 of the Food Hygiene Regulations. The registers of registerable food premises are being maintained up-to-date and are kept under constant review. In 1984 it is intended to classify the food premises in the region per reference to standards of structural and •operational hygiene with a view to setting inspection levels for food premises by reference to the standards of hygiene in operation.

38 In relation to rodent and pest control there is a specialised service in the Sligo/Leitrim area under the control of the Supervising Health Inspector. The levels of infestation can be monitored by reference to the take of bait. No equivalent service has yet been established in Donegal.

The level of inspections in schooJ.s has been higher in Sligo/Leitrim. The number of Primary Schools which to-day have not as yet installed hot water and provision for sanitary towels is the same as when the Board first surveyed these schools. However, the indications are that there have been improvements in relation to standards of cleanliness and hygiene generally in the schools.

In relation to Health Education activities, formal courses have been maintained for catering persqnnel in both Sligo/Leitrim and Donegal. The courses were maintained in association with C.E.R.T. and Bord Failte and successful students were presented with certificates in the principles and practice of food hygiene.

In relation to food and drugs sampling the Board agreed a policy on formal and informal sampling in line with the recommendations of the Public Analyst. A comprehensive programme to reflect his views has been drawn up in both Community Care areas for 1984.

The poisons regulations were introduced with effect from the 1st of March 1983. The regulations state that certain products containing poisons listed in Part (ii) of the first schedule to the regulations may be sold from a pharmacy or from a premises licensed by the Health Board where the sale is excuted personally by t.he licence holder or his named deputy. Poisons set out in part three of the fourth schedule may not be sold unless the sale is affected under the direction and control of an authorised person, a registered drugist or a registered Vetinary Surgeon specified in the licence. The statistical information in relation io the operation of the regulations is contained in the previous Table. There has been some criticism of the operation of the regu lations both by staff and Board members.

In relation to Local Authority duties generaii~Jhe Board has provided a high level of service on a agency basis to the local authorities in the area. From the statistical information cited above it can be seen that there has been a high volume of work under the planning legislation, house lettings and sanitary services generally. In particular the level of water sampling in Sligo/Leitrim has been significantly increased and it was noted during the year that there was a reduction in the number of unsatisfactory samples. In Donegal the incident involving serious contamination to Ballyshannon water supply has lead to a demand for a high level of systematic sampling of all water supplies in the region. The programme for 1984 gives high priority to water sampling.

GENERAL MEDICAL SERVICES

In addition to the direct expenditure of £1 7. 9 million there was an expenditure of £6.98 (m) on the General Medical Services Scheme during 1983. At 31st December, 1983 there were 124,407 persons eligible for General Medical Services in the North West i.e. 59.76% of the population compared with 120,805 (58.02%) at 31st December, 1982. The figures can be broken d'own as follows:

39 TABLE 13

COUNTIES 1983 1983 NUMBER PERCENTAGE NUMBER PERCEN- TAGE al 78.490 62.74% 80,543 64.38% Leitrim 15,672 56.76% 57.48%

There were 98 doctors participating in the scheme consisting of 5 former District Medical Officers, 20 former District Medical Oficers who hold income guarantees and 7 5 doctors wholly paid on a fee per item of service. 39 of these doctors are dispensing doctors, dispensing to 27,772 persons. This compares with 96 doctors participating at 31st December, 1982. There wre 68 pharmacists participating in the General Medical Services · Scheme at the end of 1983 compared to 66 in 1982.

A statistical summary of the operation of the scheme in 1983 is set out below comparing the North Western Health Board region with the National average.

TABLE 14 ------,------~ . NORTH WESTERN HEALTH BOARD NATIONAL Total No. of Consultations. 1982 1983 1982 544,515 555,785 5,5992,260 143,703 150,087 1.440,572 Total 688,218 705,872 7,439,832 TOTAL COST

TABLE 15 Overall payment per eligible patient 1982 1983 1982 1983 Consultation £19.26 £21.50 £19.15 Medicines £41.59 £43.57 £44.54 Total £60.85 £65.07 £64.69 Total No. of Prescription forms 473,061 448.475 Total cost of Prescription £4,272,311 £4.423,911 Cost of Stock Orders £882,829 £895,075

40 Certain payments are made directly by the Health Board to doctors participating in the General Medical Services Scheme and they ar as follows:

(a) Salaries in the area of doctors with guaranteed salary: Where a doctor with guaranteed salary has opted for fees and the guaranteed salary falls short of the fees to which he is entitled, the Health Board pay him the defecit. £12,823.33 was paid in 1983 to doctors in this category.

(b) Rural Dispensing Fee: a dispensing doctor is paid an annual fee in respect of each person for whom he is entitled to dispense. Total paid to dispensing doctors in 1983 was £85! 163.10.

(c) Contribution towards Locum and Other Practice Expenses: Former District Medical Officers who held guarantees in relation to payment of locum expenses have these expenses paid by the Health Board. Other participating doctors are entitled to an annual contribution towards locum and other practice expenses. The amount in respect of this allowance to doctors in 1 983 was:

(i) £29,571.73 (ii) Other participating doctors £12,993.24.

(d) Rural Practice Payments: In certain circumstnces the Health Board may pay an allowance to a doctor who lives and practices in an area with a population of less than 1, 500 or more within a 3 mile radius of that centre. Total paymentsin this category for 1983 was £30,416.22.

(e) Certain fees for Special Type Consultations and special services are paid directly by the Health Board. Expenditure incurred on this for 1983 is as follows:

(i) Total cost of fees for Sp~cial Type Consultations £41,714.13

(ii) Total Cost of Fees for Special Services £7,891 .20

DENTAL SERVICES - DONEGAL The Board adopted the Report on Dental Services 1983-1987 at their meeting in October, 1982. The Dental Services in Sligo/Leitrim were dealt with in the 1 982 Annual Report and it is proposed to deal with the services in Donegal in this re~ort . The present Dental Staff in Donegal is as follows :

PrincipSJ Dental SurgeoR Clinical DeRtal Surgeon .. 7 Private Dentists PrcMding a seMc:e under the Choice of Dentist Scheme 16

41 The numbers treated during 1983 are set out in Table 16

TABLE 16 TOTAL NUMBER TREATED DURING 1983 CHILDREN ADULTS Full Dental Examinations 11,819 4,486 9,116 2,702 1,169 1,640 Extractions : Deciduous 5,337 Extractions : Permanent 1,384 4,686 - Decidious Teeth 1,764 - Permanent Teeth 6,273 5,032 Dentures 1 3 (Full Upr) 331 (Full Lwr) (Full Upr) 91 Parts 190 Rebine 4 7,800

In 1983 all the Dental services to children were provided by the public dental officers. This enabled the private dentists, participat!ng in the "Choice of Dentist Scheme" to devote more time to treating adults.

The waiting lists for Orthodontic treatment and General Anaesthetic were almost elimated in 1983. The prevention programmes were extended in 1983 (i.e wElter fluoridation and Dental Health Education). Overall the dental·servic& .... n Donegal were extended over the level provided in 1982. The number of treatments were down on the total for 1982, although the number of patients dealt with increased which would indicate that the prevention programmes are proving effective.

42 Personnel THE PERSONNEL FUNCTION

Throughout 1 983 the highest level of staff co-operation was required to cope with the growing demands of the community for existing health services and for the development of new services, against the background of the Board's decreased financial allocation.

These cir~;umstances required the Board's Management to develop policies and priorities which ensured that the human resources available were deployed in such a way as to provide the highest level of service to the public. The Board has had to introduce policies to match the new situation and it acknowledges that without the understanding, co - operation, ideas and commitment of its staff it would not have been possible to achieve these.

Within the Boards approved policies and procedures the Board's senior (nanage·rs have been given the authority to grant leave and to employ temporary staff on a short term basis. This allows each manager to have resources and flexibility to manage at local level.

The Board made proposals to the Department of Health regarding the personnel policies which would be appropriate in the present context of high unemployment. The Board for example recommended a more liberal approach to applications for leave without pay, an examination of the possibility of phased retirement, an examination of the system for the introduction of job sharing and part-time working on a large scale. The Board is confident that with the continued commitment of its staff combined with the availability of full, accurate, relevant and up-to-date information on the Boa,rds activitiesc..it will be possible to continue to provide services of the highest quality and to retain the flexibility necessary to meet changing demands.

The Board's Staff Development Programme for all grades will receive continued. emphasis in 1 984 in order to sustain the high level of morale and to continue to provide each staff member with the skills, understanding and information necessary to maintain this.

RECRUITMENT While the overall number of vacancies continue to decrease there is the constant need for the Board to fill i(s vacancies with people of the highest calibre and expertise and to adjust to the changing skills required. Moreover, it is essential that the Board,.as the largest employer in the region,continues to operate a recruitment policy which allows equal access to all with the required skills, standards or qualifications to apply for its positions.

In time of recession the number of applications for most posts increases enormously, yet because of the very limited number of vacancies very many well qualified and talented people are disappointed.

EDUCATION, TRAINING AND STAFF DEVELOPMENT The Board's policy remains one of having a programme of continuing education and training for all categories and grades of staff. The details of some of the years education programme are given here:

Postgraduate medical and dental education continued. The programme included:- 1 . The Postgraduate Medical and Dental Board approved of the establishment of a Regional Dental Committee for the North Western Health Board area on a pilot basis and contributes financially to the costs. This Committee is composed of the Board's dentists and

43 private dentists from the North West and its main function is to promote the development of postgraduate dental education for all dentists in the North West. The educational activites of the C~mmittee .are carried out by a course organiser, Dr. B. FlanaQan, Sligo, who ts employed two sessions per week for this purpose.

Participants, speakers, and committee workers attending the first North West Dental Committee Seminar in Letterkenny General Hospital on November 19th 1983

2. The appointment of a Postgraduate Medical Co-ordinator was approved for the North Western Health Board area by the Postgraduate Medical and Dental Board in 1983. Previous to this the Co-ordinator in Galway also served the North West. The Co-ordinator for the North West is on a pilot basis and is partly funded by the Postgraduate Medical and Dental Board.

Dr. Liam Bannon, Consultant Physician, Letterkenny General Hospital, was appointed as the Co-ordinator in October 1983 for two sessions per week to promote and co -ordinate Postgratuate Medical Education for all medical staff in the North West.

3. A Library Information Scheme for General Practitioners is administered from Sligo General Hospital. The scheme which is partly funded by the Postgraduate Medical and Dental Board on a pilot basis is being developed by Dr. Paul Money, Drumcliffe, with the assistance of a secretary for four hours per week. The Scheme involves circulating participating general practitioners with the content pages of relevant journals and sending photocopies of requested articles to General Practitioners.

44 4. The General Practice Training Schemes continued at Sligo and Letterkenny. Two trainees were recruited to each scheme in 1983. At the end of the year six trainees were in training in the Sligo scheme and six trainees in the Letterkenny scheme.

Instructors & participants in the General Practice Training Scheme (Sligo General Hospitai) which continued at both of the Boards General Hospitals during 1983

A particular feature of the Sligo scheme is that non-consultant hospital doctors working in Sligo General Hospital but not formally participating in the Scheme regularly attend the academic weekly sessions.

In association with the University of Surrey, Department of Adult Education, the Board commenced a two year part-time course leading to a postgraduate certificate in the practice of Social Welfare in Mental Health. Twenty of the Boards staff, psychiatric nurses from Sligo and Letterkenny and _instructors/supervisors from the Board's workshops, are participating in the course. The objectives of this course are to give a major orientatton to the social aspects of psychiatry and to promote and develop social rehabilitation and a community approach to psychiatric problems. Those participating in the course have the opportunity to acquire knowledge and skills relating to all the major models of psychiatric care, especially in those areas dealing with counselling, family therapy and the psychological methods as alternatives to drug therapies.

In co-operation with the Irish Wheelchair Association the Board continued its programme of workshops for all staff in the Geriatric Hospitals and Community Nursing Units. This programme of training had as its objective,,improvement of team working amongst all those working in the residential centres for the elderly. A more positive attitude towards the independence of the elderly is also an objective. A system of follow-up to the workshops has been established to ensure continuation of the team working ..

45 Staff members from residential centres for the elderly in Co. Donegal whf' took part in residents/ care for the elderly training. The training sessions were organised in co-operation with the Irish Wheelchair Association. Instructor Mr A. Graham is 6th from left in back row

The training needs of the Board's catering staff have been established. C.E.R.T. assisted in this process and in organising the induction and other training. The objective of training programmes has been to improve as far as possible the catering service in the Board's institutions.

Other training programmes continued. T~aining courses were held in the region on subjects such as staff appraisal and counselling, selection interviewing, personnel management and clinical subjects for nursing and para-medical staff. Induction training and management training continued.

INDUSTRIAL RELATIONS The maintenance of good staff relations through the continued use of agreed procedures remained a priority throughout the year.

A reduction in the financial allocation for the year together with the implementation of the ministerial directive on staff reductions necessitated considerable discussion and negotiation. Despite these difficulties, no serious dispute arose locally.

All of the Board's managers continued their efforts to reduce absenteeism. The employment of an Area Medical Officer on a sessional basis to assist with staff health and welfare was agreed. The employment of two emplovees was terminated because of gross abuse of the sick leave scheme.

Major changes in the personnel aspects of the psychiatric nursing service were to result from the amendment the previous year of the Employment Equality Act 1977. A Management/Union Forum was established nationally to agreE new procedures for recruitment, promotions, integration and other aspects of the service.

The Board commenced negotiations with the unions involved to rationalise the home help service and completed o111plementation of a national agreement relating to cooks and assistant cooks. Discussions commenced to improve the rostering arrangements for catering attendant!'! in St. Columba's Hospital.

46 Finance REVENUE EXPENOIT\JRE SUIWAARY 1983 1982 1983 £000 1 .1 Hetllth Expsndtue £000 £000 Hospital Care 47,987 Comrrunity Care 24,114 66,596 Central Services 2,334 74,435 1 .2 Non Helllth Expsncltlle Supplementary Wetfare 3,145 3,705 Training Centres 1,593 4,738 70,301 TOTAL REVENUE EXPEMXTtJRE 79,173 RJNDEDBY 1. Wafate Refunds and Contributions from Dept. of Social Wf!JfaKe/ Donegal/Leitrim/Sligo 2,592 Councils 3,145 2 Centres Social Fund 740 Sales 483 1,113 Other Grants + Income 370 1,593 3.Hetllth 4,416 Miscellaneous Receipts 7,256

of Health

47 N. W. H. B. REVENUE EXPENDITURE 1983

Hospital Care 60 · 6%

Community Care 30 · 4%

48 ANALYSIS OF TOTAL EXPEMXTURE 1982 1983 Pay Non-Pay Total £000 £000 £000 £000 18,520 General Hospitals 13,898 6,360 20,258 17,790 Special Hospitals 14,623 5,914 20,537 5,680 Other Hosprtals/Homes 4,079 1,298 5,377 1,540 Arrt>ulance 824 903 1,727 100 Extern Hospitals 88 88

43,630 Sub TotJJIIItJsp/W Cowe 33,424 14,563 47,987 l+ogl.,.,. General Practitioner/General 13,724 Mecical Services 3,999 10,552 14,551 1,215 Maternity & Child Care Services 422 497 919 1,203 Dental, Op1halmic & Aural 695 725 1,420 Services 3,643 Rehabilitation 180 4,951 5,131 1,516 Other Services 541 1,552 2,093 21 ,301 Sib TotBI Cotnnxnty Cowe 5,837 18,277 24,114 l+ogl.,.,. 2,592 Supplenientary Welfare 399 2,746 3,145 1,665 Central Services 712 1,622 2,334 1,113 Training Centres 782 811 1,593

TOTAL EXPENDITURE 38,019 79,173

49 ANAlYSIS OF EXPENDITURE HOSPITAL AND HOMES 1982 1983 Total £000 HOSFfTAUHOME £000 £()()() £()()() 10,715 7,880 3,579 11,459 7,805 General 6,018 2,781 8,799 18,520 Sub-Total General Hospitals 13,898 6,360 20,258 6,030 St. Conal's 4,904 2,208 7,112 6,260 St. Columba's 5,213 2,209 7,422 1,225 St. Joseph 's 1,004 288 1,292 2,045 St. John's 1,602 577 2,179 1,050 St. Patrick's 864 254 1,118 245 J.C.M. 220 57 277 935 Cloonamahon 749 254 1,003 - St. 67 67 134 17,790 14,623 5,914 20,537 1,585 1,008 336 1,344 575 Ufford 408 121 529 735 Sheil 552 154 706 490 Camdonagh 379 190 569 525 Donegal 357 118 475 610 Dungtoe 442 119 561 110 Arus Breffni 92 26 118 140 Mohill Welfare Home 103 32 135 330 C.N.U. 272 70 342 150 Rock Welfare Home 109 51 160 365 Ramelton 299 72 371 65 Mohill Day Centre 58 9 67 5,680 Sub-Total Other Hospitals/ 4,079 1,298 5,377 Homes 1,540 Ambulance 824 903 1,727 100 88 88

50 N. W. H. B. ANALYSIS OF EXPENDITURE - PAY AND NON _PAY 1983

PAY 52%

NON- PAY 48%

ANALYSIS OF PAY BY CATEGORY £000 % 250 Porters etc. Paramedical

Maintenance

Others

51 ANALYSIS OF NON-PAY EXPENDITURE

£000 %

Blood & Blood Products

Farm & Garden

Finance (Including G.M.S. )

General Practitionerts/Pharmacists ments

52 N. W. H. B. ANALYSIS OF PAY BY STAFF CATEGORY 1983

Nursing Medical and Allied 56· 5%

Catering, Housekeeping, • Porters etc. 14 · 6%

53 CAPITAL EXPENDITURE 1983 Expenditure on On-Going Schemes during the year amounted to £2 · 408 M. This does not represent the full cost of the schemes but is the expenditure incurred on the schemes in 1983.

£000 Letterl

Training Centres/Activation Units 285 Falcarragh 59 Ramelton 30 Buncrana 107 Ballymote 105 Housing Aid for Elderly 136 Other 13 735

54 Technical Services & European Social Fund· TECHNICAL SERVICES

GENERAL The function of Technical Services is to arrange for the provision and maintenance of Health Board premises and engineering services, machinery, equipment and installations. This dual role is effected by involvement at project level on Capital Schemes and by Works Programmes on maintenance operations.

CAPITAL PROJECTS: Two major projects are at Design Stage: Letterkenny General Hospital Extension costing £3m will start by late 1984 and Sligo General Hospital Extension, on which planning is well advanced, is planned to start in mid 1 98 5 at an estimated cost of £ 1 9%. Other projects are being drafted to implement the Health Board's Community Nursing Unit Programme and include schemes in Killybegs, Carndonagh, Manorhamilton, Letterkenny, Lifford, Dungloe, Donegal and Ballyshannon. Planning is underway on the provision of a workshop for the mentally handicapped and other facilities at St. Joseph's Hospital, Stranorlar.

MAINTENANCE OPERATIONS: The task of reorganising the workforce to put into effect a planned and programmed maintenance schedule is in hand, and it is hoped to implement this early in 1 984. The deployment of maintenance personnel and supervision and administration of f .Qntract maintenance will put an additional load on the supervisory staff which can confidently be handled by lhe staff concerned.

ENERGY CONSERVATION: The programme for 1 983 has been implemented in full and will result in reduced heat losses (and cost savings) in 1984. The involvement and level of activity of Energy Committees in nearly all centres have been unacceptably low and the 1984 programme will have to take account of this fact.

FIRE AND SAFETY: Some improvements were implemented in fire alarm systems . throughout the Health Board's hospitals and other centres and a considerable increase in fire-fighting and evacuation equipment was provided in 1983. lt is hoped, in spite of cut-backs to continue this level of improvements and a submission to the Department of Health is awaiting approval to implement a planned programme for upgrading the installations. A revised and more effective programme of lectures and drills will be introduced in 1984 giving emphasis to areas of employee concentration and older premises.

TELEPHONES: Due to the installation of automatic Telecom ~lreann exchanges throughout most of the region in 1 ~83, the need has arisen to upgrade the facilities in Health Board premises to avail of the improved system. Plans are being drawn up to this end and negotiations are in progress in some cases.

STAFFING: Staffing levels have been marginally reduced in 1983 but plans are being drafted to strengthen the maintenance organisation by improving etficiencies, deployment on more productive work and some degree of specialisation.

55 EUROPEAN SOCIAL FUND During 1983, the Board's Planning and Evaluation Department was primarily concerned with dealing with applications for funds to the European Social Fund. To cater for the spcific needs of the handicapped the Board has adopted an intensive Rehabilitaton Programme and provides hostel _accommodation and social training.

To assist financing projects for the training and employment of the handicapped, applications are made annually, and in advance, for financial assistance from the European Social Fund and tPe Board is moderately successful in having funds allocated for these services - to date (including 1 983) £6. 7m was allocated.

For the calendar year 1983, £1 .8m was allocated towards the cost of provision of services at the Work Activation Units at the two Psychiatric Hospitals in Sligo and Letterkenny, the Training Centres at Cloonamahon, Stranorlar, Sligo and Letterkenny and the Community Workshops at Gweedore and Letterkenny. Financial assistance was also requested in respect of residential hostel accommoaation associated with these training facilities throughout the region.

The number of beneficiaries were as follows:

WOf'K Activation Units !raining Centres Community Workshops Instructor Training

Analysed by handicap, the figur~ are:-

Mentally Handicapped Physically Handicapped Persons suffering from psychiatric illness

In the calendar year 1 983, application was made to the European Social Fund in respect of the following services which will be provided by the Health Board in 1984: - Training for the handicapped attending courses at Work,· Activation Units, -Training Centres and Community Workshops. - Functional Rehabilitation. Orthopaedic Unit, Sligo. - Medical Rehabiilitation Centre, Manorhamilton. - New Workshops at Stranorlar and Dungloe. - Community Information Services. - Hostels and other applications, including Buncrana Community Nursing Unit and a pilot scheme on job sparing.

The initi~l steps were taken in 1 983 in respect of an application for financial assistance towards the cost of social-medical infrastructural development of the islands within the region.

At the year's end a formal decision was awaited in respect of the 1984 applications as outlined above. 56 Appendices HOSPITAL I~PATIENT STATISTICS FROM JANUARY 1983 TO DECEMBER 1983 Bed Number of Average Duration % Bed Hospital Patients Treated of Stay Medc8l

Manorhamitton 30 678 16.4 SflgO 55 2,888 7.4 Total 153 6,291 8.2

letterkenny 64 3,013 6.6 85% Sligo 69 3,253 6.5 84% Total 133 6,266 6.5 85% Maternity letterkenny 50 2,438 5.2 69%. Manomamitton 5 75 5.7 23% Sligo 30 1,821 5.7 95% Total 85 4,334 5.4 75%

19 1,218 4.3 14 741 5.8 Total 33 1,959 4.8 Paeciatric Letteri

Lett~ri

Sligo 52 1,419 11 .3 85%

Manorhamitton 28 141 25.1 35%

57 Number of Births- Letterkenny, Sligo and Manorhamllton from January 1983 to December 1983. 2,075 1,559 Manorhamilton 21

&nmary of Hospital In-Patient Statistics from January 1983 to Decarlber 1983.

Bed Number of Average Duration %Bed Complement Patients Treated of Stay 243 11 993 Manorhamilton 66 904 16.1 Sligo 301 14,872 6.5

Nlmber on Waiting Ust for Admission to General Hospitals at 31112/1983 IAI Over Less than 2 1-2 yrs 9-1 2 mths 6-9 mths 3-6 mths 1 - 3 mths 1 mth Total Medical Surgical 11 20 19 50 Paediatric 6 6 12 Gynae 1 4 17 27 13 62 Ophthalmic 5 43 22 70 E.N.T. 11 41 52 Geriatric

(8) letterbnny General Hospital Over Less than Specialty 2 yrs 1-2 yrs9-12 mths 6-9 mths 3-6 mths 1 - 3 mths 1 mths Total Medical Surgical 3 7 2 6 29 112 64 223

58 Out-Patients Clinics - 1983

(AI Sligo General Hospital

Number of Attendances Number Held New Recall Total Medical 97 353 1, 182 1,535 248 730 1,946 2,676 Gynae 99 286 578 864 Ante-Natal 98 602 1,880 2,482 Orthopaedic 162 594 2,652 3,246 St. Luke's 23 226 848 1,074 Varicose Veins 89 45 240 285 Paediatric 135 304 2,039 2,343 E.N.T. 116 800 1,492 2,292 Diaabetic 12 168 168 Opthalmic 94 440 1,980 2,420 Refraction 67 504 234 738 Dermatology 12 237 146 383 P.A. 40 13 451 464 *Rheumat- ology 15 51 35 86 Geriatric 98 126 819 945 Orthoptics 28 135 335 470 Aud 109 954 976

• Rheumatology clinics commenced in August 1 983.

59 LETTERKENNV GENERAL HOSPITAL Number of Attendances Number Held New Recall Total Medical 196 1,022 4,181 5,203 172 1, 141 4,779 5,920 Gynae 49 381 253 634 Natal 137 846 1 278 2 124 E.N.T. 89 1,025 949 1,974 Paediatric 145 551 3,168 3,719 Ophthalmic 68 368 1,384 1,752 Orthopaedic 39 243 687 930 Dental 37 264 Varicose Veins 28 5 37 42 St. Lukes 11 185 593 778 Fitter 38 128 206 334 Oral Su 13 161 68 229 Diabetic 67 3 697 700 *Rheumatol 11 112 95 207 **Neurosurgery 2 20 3 23 P.T. Clinic 863 863

*Rheumatology Out - Patient clinics commenced in August 1983

• * Neurosurgery Out-Patient clinics commenced In November 1983

SUGO GENERAL HOSPITAL - Out-Patient Clnics 1983 Breakdown of length of Ust at 31/12/83 Over Less than Specialty 2yrs 1-2 yrs 9-12 mths 6-9 mths 3-6 mths 1 - 3mths 1 mth Total Medical 10 14 15 28 25 92 Surgical 4 150 138 121 37 450 Gynae 4 4 Ante-Natal 5 5 691 187 53 75 66 58 56 1,186 V. Veins 2 2 Paediatric 12 12 E.N.T. 85 39 124 Opthalmic 32 13 45 Refraction 25 34 112 23 194 Dermatology 6 12 14 32

60 LETTERKENNY GENERAL HOSPITAl - Out-Patient Waiting list 1983 Breakdown of list at 31/12/83 Over 1 - 3 Less than Specialty 2 yrs 1-2 yrs 9-1 2 mths 6-9 mths 3-6 mths mths 1 mths Total Medical 6 101 75 182 Surgical 20 77 111 73 281 Gynae 45 45 Ante-Natal 59 59 E.N.T. 27 60 98 185 Paediatric 34 44 78 Ophthalmic 24 49 166

Nl.l'llber of Tests 1982 1983 General Hospital 552,389 619,549

OUR LADYS HOSPITAL - MANORHAMILTON

Number of Attendances Specialty Number Held New Recall Total Medical 15 42 22 Surgical 42 180 153 Gynae 24 71 84 155 Ante-Natal 23 76 107 183 Orthopaedic 27 124 141 265 Paediatric 11 11 140 1 51 Psychiatric 24 8 212 220 Rheumatology 18 60 46 106

61 Hospital In-Patient Statistics from Jaluary 1983 - December 1 983 District Hospitals No. of Bed Patients Average Duration % Bed Complement Treated of Stay Occup. Medical and Minor

Ballyshannon 47 517 28.1 85% Carndonagh 30 350 30.9 99% Donegal 22 497 18.7 116% Dungloe 37 744 16.3 89% lifford 40 499 26.9 92% Maternity Ballyshannon 5 108 4.8 28% Carndonagh 8 185 4 .1 26% Donegal 7 221 3.9 34% Dungloe 6 164 3.4 25% lifford 6 138 4 .9 31 % Paediatric Ballyshannon 3 9 6.7 5 % Carndonagh 2 14 3.1 6 % Dungloe 6 122 2.7 15% lifford 2 5 8.4 6 % TOTAL Ballyshanon 5 5 634 23.8 75% Carndonagh 40 549 21 .2 79% Donegal 29 718 14.2 96% Dungloe 49 1,030 12.6 72%

Number of Births Hospital In-Patient Statistics from January 1 983 to December 1 983

2 75 Donegal 8 8 Ufford 78

62 Out-Patient Clinics 1983 - District Hospitals Shell Hospital, 8allyshannon Number of Attendances Specialty No. Held New Recall Total Medical 12 32 32 Ante-Natal 14 102 83 185 Gynae 14 20 15 35 Orthopaedic 22 126 184 310 Dental 12 116 24 56 225 281 39 22 257 279 Geriatric 22 36 81

~ Dlstrlct Hospital Number of Attendances Specialty No. Held New Recall Total &.rgical 12 141 82 223 Gynae 25 213 296 509 Ophthalmic 13 169 235 404 Psychiatric 549 563

Donegal District Hospital Number of Attendances No. Held New Recall Total Surgical 12 112 139 251 Maternity/- Gynae 25 357 510 867 Paediatric 52 123 446 569 Ch 23 301 Psychiatric 24 38 270 308 St. Luke's 12 63 351 414 Ophthalmic 22 322 156 478

63 Dungloe District Hospital Number of Attendances Specialty No. Held New Recall Total Maternity/- 25 321 451 772 28 34 266 300 Ophthalmic 16 188 225 4 13 51 42 478 520 106 191

llfford District Hospital Number of Attendances Specialty No. Held New Recall Total 0 hthalmic 10 153 115 268 Dental 16

Buncrana Health Clinic Number of Attendances No. Held New Recall Total 26 339 616 955 12 136 41 177 12 188 166 354

St. Patricks Canick-on-Shannon. Number of Attendances No. Held New Recall Total Paediatric 35 103 399 502 10 22 130 152

64 Statistics for Geriatric Hospitals from January 1983 to December 1983 Bed No. of No. of New No. %Bed Hospital Complement Admissions Admissions Discharged Occupancy St. John's 354 470 437 302 101 % St. 's 200 161 98 108 100% St. Patrick's 133 343 190 78%

AT234

from .hnJay 1983 to December 1983. No. on Register Total New Total Hospital at end of month Admissions Admissions Discharges St. Columba's 547 669 154 812 St. Conal's 470 1,003

In-Patient Stadstk:s for Wtlfrn Homes January 1983 to December 1983 Bed No. of No. of New No. of % Bed Welfare Home Complement Admissions Admissions Discharges Occupancy Baltyshannon 35 12 12 8 97% Manorhamilton 40 8 7 3 98% Mohill 40 5 5 99%

65 Psychiatric. Hospital, - Out-Patient Clnlcs 1983 St. Columbas Hospital, Sigo. No of attendances Clinic Centre No. Held New Recall Total Easkey 23 9 177 186 Sligo 51 88 622 710 Ballymote 24 17 277 294 Tubbercurry 24 16 178 194 Manorhamilton 24 8 212 220 Kinlough 24 8 126 134 ~ - Drumshanbo 24 20 174 194 Mohill 24 23 281 304 Ballyinamore 24 3 181 184 Carrick -on-Shannon 23 12 117 129 Ballyshannon 39 22 279 301 Gurteen 11 2 62 64 Cliffoney 7 56 50

St. Conals Hospital, Lettertdilybofey 23 21 179 200 Donegal 24 38 270 308 Bunbeg 23 4 130

66 Appendices Community Care Extract from on Activities of local Committees from 1976 • 1983 Services 1976 1977 1978 1979 1980 1981 1982 1983 Number of Committees 79 83 91 93 96 98 99 95 Meal Service Total number meals supplied 68,016 68,396 68,637 8 78,538 67,079 Number of towns and villages in the region in which this service was 47 48 53 59 61 49 54 40

Total number in receipt of service 281 351 405 351 404 418 515 711 Number of locations at which this service was provided throughout the 33 38 40 40 37 43 4 1 43 The Board's contribution towards this £3,709 £14,868 £7,281 £8,740 £10,320 £18,181 £20,854 £20,5- 36.33 The following number of households benefited 569 646 676 589 659 707 570 555 From the Home Help Service provided through the Voluntary Organisations in towns and 73 73 77 80 74 64 66 68 The Board's contribution towards the service was £90,532 £93,836£154,776£189,372£210,060£277,387£257,097 £193,- 253.53 In addition to the service provided through Voluntary Organisations the Board, by the direct employment of full-time and part-time Home Helps provided a home help service for a further 236 210 372 504 485 660 709 831 Households so that the total number of households who benefited from the service was 805 856 1048 1,093 1,144 1,367 1,279 1,450 Fuel Service

The National Fuel Scheme which was introduced in the latter part of 1 980 replaced the Free Fuel Scheme which had previously been operated by Voluntary Organisations at locations throughout the region for certain categories of elderly people. The total number who benefitted from the National Fuel Scheme was 9 , 8 61•. The Board's contribution towards this service was £1 ,2 7 4,204. This figure represents no. of recipients for period October. 1. 981 - April1982 (i.e. operative dates of 81 - 82 fuel scheme).

ational Fuel Scheme 82/'83 \lo. Receipients 9,903

67 Extract from Report on Activities of Local VoUmlry Committees from 1976 - 1982 (Contrtued) Services Chiropody Services 1976 1977 1978 1979 1980 1981 1982 Chiropody Services were provided by Voluntary Organisations for a total of 96 142 186 125 133 187 146 Persons and the Board Contributed £394 £554 £1,009 £1 ,303 £2,895 £22,58 £1 ,753

£75 £200 £500 £155 £150 £300 £150 2 3 8 3 2 4 3 Committees who were set up

Where a Voluntary Organisation undertakes a home improvement for an eligible person and such improvement does not qualify for financial assistance from State or other sources (e.g. supplementary grantS from the housing authority) the Board will pay up to a maxium of £30 in any case where the *1/9/79 £60 improvement can be seen to be of benefit to the health and/or welfare of the eligible persons concerned. A total of 9 7 53 47 23 57 22 persons benefited under the scheme for which the Board

Maternity Cash Grant Year Number of Applicants 1976 ------~-- 1977 1978 1979 1980 1981

68 Numbers who benefited under scheme Year Women Children 1976 10 760 1977 17 782 1978 7 645 1979 39 542 1980 73 763 1981 76 779 3 349

Bi1hs Assigned Assigned Assigned Year Registered to Donegal Register to Sligo Register to Leitrim 1976 2,188 2,3,15 110 444 1,210 1977 2,246 2,411 94 445 • 1978 2,302 2,490 60 506 1979 2,315 2,540 53 468 1,564 1,117 1980 2,317 2,583 45 497 1,564 1,038 1981 2,508 533 1,595 1,055

Alowance towards the Cost of Drugs Year Number of Claims 1976 326 per month 1977 373 per month 1978 55 5 per month 1979 703 per month 1980 1,197 per month 1981 1,321 per month 1982 1,196 per month

69 LONG TERM ILLNESS SCHEME Number of persons availing of scheme with the following Diseases 1976 1977 1978 1979 1980 1981 1982 1983 Mental Handicap 13 15 20 38 43 49 59 80 Mental lllnesss 14 10 10 18 19 20 18 19 Phenylketonuria 10 9 11 13 13 14 11 17 Cystic Fibrosis 11 13 17 21 20 27 24 19 Bifida 12 19 21 30 29 29 29 28 Hydrocephalus 6 5 5 6 6 6 4 6 Cerebral Palsy 6 4 7 8 9 8 3 15 Haemophilia 1 1 1 1 4 4 10 3 Epilepsy 173 151 232 308 346 384 397 403 Multiple Sclerosis 13 11 15 29 31 38 40 47 Muscular Dystrophies 2 2 2 5 5 5 5 8 Parkinsonism 18 21 24 28 31 32 26 30 Acute Leukemia 1 2 5 11 18 9 Brucellosis 3 4 5 14 9 6

Infectious Diseases (Maintenance) Alowance 1976 1977 1978 1979 1980 1981 1982 No. of persons (excluding dependants) receiving allowances: (a) In Institutions 4 1 1 2 2 1 (b) At Home 30 35 29 26 24 32 31 (c) For Domestic Help 1 1 2 5 9 4 (d) Outgoing on Premises 0 No. of Dependants (e) Adult 13 11 8 10 8 12 9 (f) Child

70 Alowances for ~ Care of Hadcapped Chlc:hn Number of children in respect of Year who~ . allowances are being paid 1976 145 1977 148 1978 161 1979 187 1980 206 1981 241

Bhi Welfare 1976 1977 1978 1979 1980 1981 1982 No. of Blind Persons over 16 years and under 21 years Nil Nil Nil Nil Nil Nil Nil Nil No. of Blind Persons over 21 years who are ~ single, widow or widowers (a) Uving Alone 24 22 22 22 23 27 32 29 (b) Not Alone 86 95 98 80 75 79 65 69 No. of blind married men with sighted wife 16 14 13 11 8 8 7 7 No. of sighted married men with blind wife 9 10 8 8 7 4 8

Disabled Per8ons (Mairtenance) RegUations 1976 1977 1978 1979 1980 1981 1982 No. of Receipients of such allowances 2,258 2,102 2,055 1,981 2,004 1986 1,886

(a) at appropriate maxim..~m rate 1,643 1,428 1,417 1,372 1,400 1512 1,464 (b) at less than maximum rate 615 674 638 609 604 474 422 No. of applicants. 325 338 300 326 361

71