The Royal Hospital Donnybrook Annual Report & Accounts 2010 Contents

The Royal Hospital Donnybrook Dublin 4 Ireland

Telephone +353 (0)1 406 6600 Fax +353 (0)1 406 6605 e-mail [email protected]

www.rhd.ie

Annual Report & Accounts 2010 Contents

Chairman’s Statement 4 Chief Executive’s Report 6 Medical Report 8 Nursing Report 10 Allied Health Services 12 Complex Continuing Care 14 General Rehabilitation 16 Stroke Rehabilitation 18 Adult Disability (Maples Unit) 20 Phoenix Unit 22 Day Hospital 24 Human Resources 26 Financial Controller’s Report 28 Financial Statements I-XV The Royal Hospital Donnybrook Aos Óg programme and Dublin 4 Gaisce – The President’s Award Ireland – list of participating schools 47

Telephone +353 (0)1 406 6600 List of Governors 48 Fax +353 (0)1 406 6605 e-mail [email protected] www.rhd.ie

Annual Report & Accounts 2010 1 Board of Management Audit Committee Senior Management Team Consultant in Rehabilitation Medicine Frank Cunneen (Chairman) Jerry Kelly (Chair) Chief Executive Jerry Kelly (Vice-Chairman) Michael Forde Graham Knowles Dr. Áine Carroll Michael Forde (Treasurer) Alastair Graham Medical Director Dr. Lisa Cogan Finbar Costello Robin Simpson Director of Nursing Peter Gleeson Victor Stafford (retired from Consultants in Olivia Sinclair Alastair Graham Audit Committee December 2010) Geriatric Medicine Allied Health Services Manager Miriam Hillery Heather Walsh Dr. J. J. Barry Prof. Geraldine McCarthy Financial Controller Dr. Morgan Crowe Cllr. Eoghan Murphy Clinical Governance Paul Flood Dr. Diarmuid O’Shea (nominated by Dublin City Council) Committee Human Resources Manager Dr. Alan O’Grady Mary Hansell Tom Hayes (Chair) Cllr. Oisin Quinn (nominated by Dublin City Council) Prof. Geraldine McCarthy Executive Committee Graham Richards Dr. Lisa Cogan Robin Simpson Dr. Diarmuid O’Shea Frank Cunneen (Chair) Victor Stafford Dr. Áine Carroll Dr. Lisa Cogan Olivia Sinclair Paul Flood Marie McMahon Michael Forde Nominations and Heather Walsh Mary Hansell Governance Committee Patricia O’Reilly Jerry Kelly Graham Knowles Frank Cunneen (Chair) Robin Simpson Finbar Costello Olivia Sinclair Miriam Hillery Victor Stafford Jerry Kelly Heather Walsh Graham Richards The Royal Hospital Donnybrook is a registered charity – No. CHY 982

2 The Royal Hospital Donnybrook Annual Report & Accounts 2010 Senior Management Team Consultant in Senior Staff Rehabilitation Medicine Chief Executive Clinical Nurse Manager (3) Principal Medical Social Worker Graham Knowles Dr. Áine Carroll Marie McMahon Mary Duffy Medical Director Dr. Lisa Cogan Clinical Nurse Managers (2) Senior Speech & Language Therapist (vacant) Director of Nursing Consultants in Anne Dooley Olivia Sinclair Geriatric Medicine Elaine Foley

Allied Health Services Manager Patricia O’Reilly Senior Dietitian Heather Walsh Dr. J. J. Barry Zoe McDonald Maura Geaney Dr. Morgan Crowe Financial Controller Emer Kennedy Paul Flood Dr. Diarmuid O’Shea Podiatrist Mary Mae Salomon Brid Waldron Human Resources Manager Mary Hansell Sinead McDonnell General Services Manager Clinical Nurse Managers (Night) Thomas O’Brien Executive Committee Anne Migchels Information Communication Frank Cunneen (Chair) Michael Guare Technology Manager Dr. Lisa Cogan Derek Mulcahy Physiotherapy Manager Paul Flood Barbara Sheerin Michael Forde

Mary Hansell Occupational Therapy Manager Jerry Kelly Heather Walsh Graham Knowles Robin Simpson Olivia Sinclair Victor Stafford Heather Walsh The Royal Hospital Donnybrook is a registered charity – No. CHY 982

The Royal Hospital Donnybrook Annual Report & Accounts 2010 3 Chairman’s Statement “ The overriding objective remains to continue to enhance the medical, nursing and therapeutic capability of the RHD to allow it to care for ever more complex-needs patients”

I am pleased to present the Annual Report rheumatology at the Mater Misericordiae The Clinical Governance Committee has unique caring ethos of The Royal Hospital for 2010 and the Audited Accounts University Hospital, joined the board and commenced its meetings under the expert Donnybrook. for the year ended 31st December last. has been most valuable to it in its work. chairmanship of Tom Hayes, a partner and Everyone will remember the very difficult It will be no surprise to learn that the I am also very pleased to say that, during head of the Healthcare Group in Matheson winter of November and December of year was challenging from a number of the year, Olivia Sinclair, RGN, MSc., was Ormsby Prentice Solicitors. This committee, 2010 when levels of snow not seen since standpoints. The general economic and appointed Director of Nursing. Olivia, who with its independent chair, provides 1947 provided a serious challenge to the financial outlook has been a particular was previously Acting Director of Nursing, oversight of clinical risk management staff to get to work and fulfill their roles. concern. The hospital’s budget, in line with combines a wealth of front line experience and medical ethics for the board in this I am proud to say that the standard of care general cutbacks, was reduced by 8.1%. acquired in The Royal Hospital Donnybrook complex area of its responsibility. We are for our patients continued, regardless of During the year, it also became apparent (RHD) with formal professional and delighted to have Geraldine McCarthy the weather. Various areas of the hospital that the outlook for 2011 and 2012 management qualifications. It is intended as the representative of the Board of were utilised for overnight accommodation was, if anything, more uncertain from a to recruit an Assistant Director of Nursing Management on this committee. for staff to ensure that they were present budgetary standpoint. to complement the management resource In the same context, the board for duty next morning. To one and all – Accordingly, the management team, in that function. continued its development of the you are an example of what The Royal supported by the Board of Management, During 2010, the RHD undertook governance of the hospital to best practice Hospital Donnybrook represents! continued its practice of ongoing cost a board evaluation survey which was standards. The Audit Committee is The Voluntary Housing Association reduction without, it has to be stressed, provided pro bono by Prospectus operating an internal audit programme on (VHA) continued its various activities; the reducing patient care. Because of this Consulting under the leadership of David a three-year cycle and provides oversight Bloomfield Apartments are fully occupied prudent approach, I am happy to say that Duffy. This valuable contribution to The of the hospital’s risk management system. and essential remedial work continues in the outcome for 2010 showed a surplus Royal Hospital Donnybrook, through During the year, The Royal Hospital Cullenswood. Again, the weather in the of about e200,000 which will help to the development of the board, is much Donnybrook underwent an unannounced winter of 2010 proved challenging and cushion inevitable cuts in the next year appreciated. inspection by the Health Information and a special effort was made to ensure the or two. More importantly, it will allow During the year the board, with the Quality Authority (HIQA) and, as might have residents wanted for nothing during the the hospital to continue to provide its management team, continued its work been anticipated, its findings were very cold spell. traditional level of care. on developing and refining its strategy positive. Both scheduled and unannounced The Friends of The Royal Hospital As was recommended by the for the period 2011-2013. The overriding inspections will be a regular feature of the Donnybrook deserve our sincere thanks Nominations and Governance Committee, objective remains to continue to enhance hospital’s interface with that organisation. for their help in undertaking a number of the Board of Management continued the medical, nursing and therapeutic On behalf of the Board of Management, fundraising events throughout the year, its work of improving its balance of capability of the RHD to allow it to care I would like to thank every member of including their renowned golf outing. Their experience and expertise. I am delighted for ever more complex-needs patients. A the staff for their ongoing commitment ongoing financial support is a valuable that, during the year, Professor Geraldine new three-year plan will be finalised early and adherence to the highest standard cushion to the hospital in these financially McCarthy, MD, FRCPI, a consultant in in 2011. of medical intervention, added to the challenging times.

4 The Royal Hospital Donnybrook Annual Report & Accounts 2010 Chairman’s Statement “ The overriding objective remains to continue to enhance the medical, nursing and therapeutic capability of the RHD to allow it to care for ever more complex-needs patients”

The Clinical Governance Committee has unique caring ethos of The Royal Hospital The Volunteers, including a number of commenced its meetings under the expert Donnybrook. transition year secondary school students, chairmanship of Tom Hayes, a partner and Everyone will remember the very difficult visit patients and residents in the hospital. head of the Healthcare Group in Matheson winter of November and December of They deliver a very valuable service in Ormsby Prentice Solicitors. This committee, 2010 when levels of snow not seen since providing recreational activities and with its independent chair, provides 1947 provided a serious challenge to the companionship to patients and residents. oversight of clinical risk management staff to get to work and fulfill their roles. The hospital enjoys the very considerable and medical ethics for the board in this I am proud to say that the standard of care benefit of a Board of Management with a complex area of its responsibility. We are for our patients continued, regardless of wealth of expertise and experience. I wish delighted to have Geraldine McCarthy the weather. Various areas of the hospital to thank board members and, in particular, as the representative of the Board of were utilised for overnight accommodation committee chairpersons and especially Management on this committee. for staff to ensure that they were present the Honorary Officers, Jerry Kelly, Vice In the same context, the board for duty next morning. To one and all – Chairman, and Michael Forde, Honorary continued its development of the you are an example of what The Royal Treasurer. I take this opportunity to record governance of the hospital to best practice Hospital Donnybrook represents! my appreciation for the advice and support standards. The Audit Committee is The Voluntary Housing Association I receive. operating an internal audit programme on (VHA) continued its various activities; the a three-year cycle and provides oversight Bloomfield Apartments are fully occupied of the hospital’s risk management system. and essential remedial work continues in During the year, The Royal Hospital Cullenswood. Again, the weather in the Frank Cunneen Donnybrook underwent an unannounced winter of 2010 proved challenging and Chairman inspection by the Health Information and a special effort was made to ensure the Quality Authority (HIQA) and, as might have residents wanted for nothing during the been anticipated, its findings were very cold spell. positive. Both scheduled and unannounced The Friends of The Royal Hospital inspections will be a regular feature of the Donnybrook deserve our sincere thanks hospital’s interface with that organisation. for their help in undertaking a number of On behalf of the Board of Management, fundraising events throughout the year, I would like to thank every member of including their renowned golf outing. Their the staff for their ongoing commitment ongoing financial support is a valuable and adherence to the highest standard cushion to the hospital in these financially of medical intervention, added to the challenging times.

The Royal Hospital Donnybrook Annual Report & Accounts 2010 5 Chief Executive’s Report “ The success of the services depends on a balanced mix of clinical, social and recreational care, based on the identification of patients’ individual requirements”

The last strategic plan for the hospital Across general rehabilitation and • Health There were other challenges too, covered the period 2007-2009 inclusive, stroke, the comprehensive nature of the • Independent lifestyles and choice some unforeseen. One such challenge and progress toward its implementation discharge planning process – which is was an ‘all out strike’ by a trade union • Quality of life was outlined in the last Annual Report. key to successful outcomes and patient representing approximately one third of Toward the end of 2010, we actively experiences – contributed to continued • Dignity the hospital’s staff. This was successfully commenced the development of a further high discharge home (as opposed to • Respect resolved without patient care being three year plan, spanning 2011 to 2013 nursing home) rates. The Day Hospital also The ongoing programme of repair and compromised. Operational plans put in inclusive. This will be achieved against contributed to admission avoidance and the refurbishment continued in many areas of place ensured continuity of service, and I the backdrop of the prevailing economic maintenance of people in their own homes the hospital. Significant works included thank my colleagues for their commitment conditions and specifically the impact of and saw an increase in its activity levels. the commencement of a new expanded and resolve during that period. those conditions on the health sector as Our complex continuing care units seating clinic, the introduction of an We depend on the dedication and a whole. responded well to the challenges of “Fair “activities of daily living” suite, additional professionalism of all our staff and, Whilst additional investment in our Deal” and HIQA (Health Information and car parking and ring road, commencement throughout the year, everyone rose to services over the period ahead is unlikely, Quality Authority). Potential admissions of a new waste yard to meet modern the challenges superbly. The Board of there are opportunities to refocus our were screened to ensure that only standards and the refurbishment of many Management remains dedicated and give services, building on the strengths we individuals requiring the level of support communal areas. Beyond the bricks and freely of their time. Volunteers and the have accumulated over the years and available in the RHD were admitted. We mortar, we created a new communal space Friends of The Royal Hospital Donnybrook positioning ourselves within the local had our first HIQA inspection (Residential with an eye catching sculpture, funded continue to play an active part in the life health economy. Continual development Services for Older People). This was through the HSE Per Cent for Art scheme of the hospital. I thank them all. of the organisation is always a necessity, unannounced and the report – which was linked to our recent expansion. whether the economic realities are positive overall - is available on our website. We continued to seek efficiencies and, favorable, benign or negative. The success of the services outlined whilst challenging, delivered on a reduced During 2010, we streamlined our adult above depends on a balanced mix of budget in 2010 with no service reduction. Graham Knowles services in the Maples and Phoenix units, clinical, social and recreational care, based Indeed, in preparing for likely further Chief Executive offering distinct pathways. Across these on the identification of patients’ individual budget reductions in 2011 and 2012, we two units, we offer needs assessment, requirements. Five core tenets underpin were able, for the first time, to generate a therapeutic reassessment, continuing our approach to care, which centre on surplus at the end of 2010 which will go neurological rehabilitation, slow stream providing patients and residents with the toward the difficult period ahead. rehabilitation, disorders of consciousness fundamental outcomes that those in more and neuro-palliative care. fortunate circumstances take for granted:

6 The Royal Hospital Donnybrook Annual Report & Accounts 2010 Chief Executive’s Report “ The success of the services depends on a balanced mix of clinical, social and recreational care, based on the identification of patients’ individual requirements”

• Health There were other challenges too, • Independent lifestyles and choice some unforeseen. One such challenge was an ‘all out strike’ by a trade union • Quality of life representing approximately one third of • Dignity the hospital’s staff. This was successfully • Respect resolved without patient care being The ongoing programme of repair and compromised. Operational plans put in refurbishment continued in many areas of place ensured continuity of service, and I the hospital. Significant works included thank my colleagues for their commitment the commencement of a new expanded and resolve during that period. seating clinic, the introduction of an We depend on the dedication and “activities of daily living” suite, additional professionalism of all our staff and, car parking and ring road, commencement throughout the year, everyone rose to of a new waste yard to meet modern the challenges superbly. The Board of standards and the refurbishment of many Management remains dedicated and give communal areas. Beyond the bricks and freely of their time. Volunteers and the mortar, we created a new communal space Friends of The Royal Hospital Donnybrook with an eye catching sculpture, funded continue to play an active part in the life through the HSE Per Cent for Art scheme of the hospital. I thank them all. linked to our recent expansion. We continued to seek efficiencies and, whilst challenging, delivered on a reduced budget in 2010 with no service reduction. Graham Knowles Indeed, in preparing for likely further Chief Executive budget reductions in 2011 and 2012, we were able, for the first time, to generate a surplus at the end of 2010 which will go toward the difficult period ahead.

The Royal Hospital Donnybrook Annual Report & Accounts 2010 7 “ The maintenance and improvement of the hospital’s reputation in clinical performance and governance remained the first priority”

infection control and topical issues relating to nursing home care. This conference was very well attended and was an opportunity to promote the RHD’s enhanced care model for residents in complex continuing care. A number of clinical research projects were progressed during 2010. These were presented at both international and local conferences and have helped strengthen Medical Report the RHD’s reputation as a centre of excellence in the care of complex The Medical Department saw a number of are provided in the Maples and Phoenix Education & Research continuing care residents. An analysis of developments and enhancements in 2010, units, for patients under the age of 65. the transfer of acutely unwell patients In 2009, the RHD achieved teaching another successful year in the face of Complex continuing care facilities, located from the RHD to the acute hospital hospital status and is now academically continuing challenges. The maintenance in the Cedars, Oaks and Larches units, are emergency department, demonstrated the linked to University College Dublin. Medical and improvement of the hospital’s dedicated to residents over the age of 65 appropriateness of the existing patient students from UCD, in their penultimate reputation in clinical performance and with complex needs and multiple co- transfer regime, highlighting success in year, rotate through complex continuing governance remained the first priority, morbidities, living through the latter stages avoiding unwarranted hospital admissions. care and the over-65 rehabilitation service. while teaching hospital status has been of their lives. In 2010, all admissions to this A study of residents who had suffered Dedicated teaching sessions are given by enhanced with significant research output. facility were mediated through the Fair strokes in our complex continuing care the Medical Director, consultant Challenges included the dissolution of the Deal Scheme. unit found a greater level of geriatricians and the multidisciplinary team, medical administration department in the The General and Stroke Rehabilitation multidisciplinary and medical input than in addition to the dedicated tutor. aftermath of the HSE voluntary Unit admits patients over the age of 65 the national average. There are higher The RHD is a host institution for the redundancy scheme that came into for post acute rehabilitation, with dependency needs in diploma in medicine for the elderly exam operation at the close of 2010. particular emphasis on rehabilitating the the RHD stroke group, with greater for GP trainees. The medical staff at the frailer older person, often avoiding long cognitive impairment, mobility needs and RHD participate in the weekly journal club term placement in a nursing home with communication difficulties. An impact of the Department of Medicine for the Clinical obvious benefits for the individual, their study of the RHD’s weekly medication Elderly in St. Vincent’s University Hospital. The range of rehabilitation and complex families and society as a whole. The Day monitoring review programme In April 2010, the RHD, in conjunction continuing care at the RHD provides the Hospital provides an essential community demonstrated a clinically meaningful with St. Vincent’s University Hospital, highest quality of clinical, therapeutic and service, enabling people to stay in their reduction in the prescribing of hosted the Dynamics of Quality Care nursing care for all our residents and homes and thereby avoid or shorten acute psychotropic medication for our complex Conference. Multidisciplinary lectures patients. Post acute rehabilitation services hospital admissions. continuing care residents. covered end of life care, HIQA guidelines,

8 The Royal Hospital Donnybrook Annual Report & Accounts 2010 “ The maintenance and improvement of the hospital’s reputation in clinical performance and governance remained the first priority”

infection control and topical issues Service Development dependent on the dedication and relating to nursing home care. This commitment of the consultant In the prevailing economic environment, conference was very well attended and geriatricians: Dr. Morgan Crowe, Dr. there was no expansion of clinical services was an opportunity to promote the RHD’s Diarmuid O’Shea and Dr. JJ Barry, who lead but considerable effort was put into enhanced care model for residents in the general rehabilitation and stroke improvement and enhancement. The complex continuing care. services. Dr. Áine Carroll, consultant in Maples Unit (formerly the Adult Disability A number of clinical research projects rehabilitation, continues to lead the Unit), which provides care for patients were progressed during 2010. These were Phoenix Unit and provides a spasticity under the age of 65 with a spectrum of presented at both international and local service to all clinical areas of the hospital. chronic illness, physical and neuro- conferences and have helped strengthen Throughout 2011, we will strengthen disabilities, was comprehensively the RHD’s reputation as a centre of our existing partnerships with St. Vincent’s reconfigured. It now has four dedicated excellence in the care of complex University Hospital, the National clinical activity areas: slow stream continuing care residents. An analysis of Rehabilitation Hospital and UCD and, rehabilitation; disordered consciousness; Education & Research the transfer of acutely unwell patients at the same time, explore other neuro-palliative, and longer term care for In 2009, the RHD achieved teaching from the RHD to the acute hospital potential collaborations. adults with disability. hospital status and is now academically emergency department, demonstrated the With regard to the transfer of acutely linked to University College Dublin. Medical appropriateness of the existing patient unwell patients from the RHD to the students from UCD, in their penultimate transfer regime, highlighting success in Dr Lisa Cogan | Medical Director emergency department at St. Vincent’s year, rotate through complex continuing avoiding unwarranted hospital admissions. University Hospital, communication care and the over-65 rehabilitation service. A study of residents who had suffered pathways were improved, thereby ensuring Dedicated teaching sessions are given by strokes in our complex continuing care their safe and timely transfer. In addition, the Medical Director, consultant unit found a greater level of opportunities in the development of an geriatricians and the multidisciplinary team, multidisciplinary and medical input than out-patient falls clinic within the Day in addition to the dedicated tutor. the national average. There are higher Hospital facility are being explored with The RHD is a host institution for the dependency needs in the HSE and potential industry diploma in medicine for the elderly exam the RHD stroke group, with greater collaboration. Finally, the medical for GP trainees. The medical staff at the cognitive impairment, mobility needs and department is actively supporting the RHD participate in the weekly journal club communication difficulties. An impact board in the promotion of a robust and of the Department of Medicine for the study of the RHD’s weekly medication transparent integrated governance system Elderly in St. Vincent’s University Hospital. monitoring review programme to ensure patient safety. In April 2010, the RHD, in conjunction demonstrated a clinically meaningful In conclusion, the challenges to providing with St. Vincent’s University Hospital, reduction in the prescribing of the highest quality service to our clinical hosted the Dynamics of Quality Care psychotropic medication for our complex areas will heighten in the forthcoming year. Conference. Multidisciplinary lectures continuing care residents. covered end of life care, HIQA guidelines, The Medical Department is enormously

The Royal Hospital Donnybrook Annual Report & Accounts 2010 9 escalated to the corporate risk register by the senior management team following discussion. The risk register policy, developed in 2008, was reviewed in 2010 and incorporated into a broader risk management policy. In her role as tissue viability nurse, Marie McMahon continued to assist staff in the assessment of residents’ and patients’ needs in relation to wounds and the development of individualised care plans to manage same. Policies in relation to pressure ulcer prevention and management and the management of wounds were developed in 2010 which will further help to enhance the quality of care delivered. Nursing Report The Hygiene Group continued to meet during 2010 and includes a member of staff from each unit and department. Nurses and nursing support staff • Medication management for nurses both residents and staff and the findings During the year, infection prevention and continued to provide high quality resident • Blood transfusion and administration of the inspection were utilised to inform control remained a priority. There was one and patient care in all service areas of the training our continuing quality improvement outbreak of the norovirus infection in the hospital. Led by the clinical nurse manager, agenda. • Food hygiene training (primary food hospital in April 2010, which was nursing staff, care assistants, household Marie McMahon, Environmental safety for household staff) managed and contained within the unit staff and ward clerks worked Manager, had a busy, proactive year in affected. New infection control policies • Infection prevention and control collaboratively with other members of managing risk throughout the hospital. All were developed or updated in 2010 multidisciplinary teams to • Healthcare risk waste training clinical and non-clinical incidents reported including standard precautions, provide person-centered services to people • Incident reporting and management continue to be logged in the Clinical transmission based precautions and MRSA with complex healthcare needs. Indemnity Scheme Database. Monthly • Major incident training guidelines. A hand hygiene audit was As is the ethos of the hospital, education reports are provided to all managers and (command and control) carried out towards the end of 2010, and training continued to be given the reviewed by the Incident Review Group highlighting areas of good practice and • Evacuation planning and training. highest priority in 2010. Sinead and the Health, Safety and Emergency opportunities for improvement. McDonnell, Education Co-ordinator, Clinical nurse managers from the Planning Working Group. They are also The hospital has been involved in the ensured that staff received the training complex continuing care units for older discussed at the regular meetings between Hospice Friendly Hospitals programme and education necessary to deliver people, in conjunction with the education hospital management and consultants. since its inception, having contributed to evidence-based, person-centred care. As co-ordinator, continued to utilise the HIQA At unit level, nurse managers continue standards development, and participating well as mandatory training in safer moving National Quality Standards to guide to be responsible for the development and in the National Audit of End of Life Care. and handling, basic life support, elder practice developments and quality maintenance of the risk register for their As a result of this involvement, significant abuse awareness and fire safety, examples initiatives. The first inspection of our area of responsibility. Risks identified at changes have been made to the provision of other training delivered in 2010 continuing care units took place in March local level, that are felt to be beyond the of end of life care. During 2010, the included: 2010. The experience was welcomed by control of the local managers, may be hospital’s multidisciplinary Hospice Friendly

10 The Royal Hospital Donnybrook Annual Report & Accounts 2010 escalated to the corporate risk register by Hospitals forum developed a project Trips organised in 2010 included the the senior management team following template based on the National Quality Aviva Stadium, the Criminal Courts, discussion. The risk register policy, Standards for End of Life Care, and we Argillan Castle and Áras an Uachtaráin, developed in 2008, was reviewed in 2010 are actively reviewing our practices against to mention a few. and incorporated into a broader risk each standard. Clinical nurse managers and their management policy. The Pastoral Care service in the hospital colleagues will present the annual report In her role as tissue viability nurse, Marie continued to be accessed by residents, on activity and developments for 2010 for McMahon continued to assist staff in the patients and relatives. Throughout 2010, their specific service areas and outline plans assessment of residents’ and patients’ Carolyn O’Laoire continued to provide for 2011. I would like to thank nursing, needs in relation to wounds and the spiritual and emotional support to all of nursing support and all of the staff development of individualised care plans those individuals accessing the service. mentioned in this report for the dedication to manage same. Policies in relation to Fr. Enda Watters retired from the hospital and commitment they have shown pressure ulcer prevention and in 2010 after providing many years of throughout 2010 and for their ongoing management and the management of service as Chaplain. We wish him a long enthusiasm in these challenging times. wounds were developed in 2010 which and happy retirement. will further help to enhance the quality of Co-ordinated by Neasa O’Donoghue, care delivered. the Volunteer service has continued to Olivia Sinclair | Director of Nursing The Hygiene Group continued to meet expand its membership during 2010 and during 2010 and includes a member of the valuable contribution of all volunteers staff from each unit and department. is to be commended. A number of new both residents and staff and the findings During the year, infection prevention and volunteers have started in the hospital of the inspection were utilised to inform control remained a priority. There was one offering such services as hand massage, our continuing quality improvement outbreak of the norovirus infection in the manicure, art, computer training and visits agenda. hospital in April 2010, which was to new residents. Marie McMahon, Environmental managed and contained within the unit These people join the wider volunteer Manager, had a busy, proactive year in affected. New infection control policies team, many of whom have attended the managing risk throughout the hospital. All were developed or updated in 2010 hospital on a weekly basis for years. In clinical and non-clinical incidents reported including standard precautions, recognition of the efforts of volunteers, we continue to be logged in the Clinical transmission based precautions and MRSA celebrated the National Day of Indemnity Scheme Database. Monthly guidelines. A hand hygiene audit was Volunteering on October 1st with an reports are provided to all managers and carried out towards the end of 2010, afternoon tea in the hospital’s Concert Hall reviewed by the Incident Review Group highlighting areas of good practice and which was a great success. Transition year and the Health, Safety and Emergency opportunities for improvement. students coming from schools around the Planning Working Group. They are also The hospital has been involved in the Dublin area continued to participate in the discussed at the regular meetings between Hospice Friendly Hospitals programme Aos Óg programme and Gaisce – The hospital management and consultants. since its inception, having contributed to President’s Award. Schools participating in At unit level, nurse managers continue standards development, and participating 2010 are listed on page 47. to be responsible for the development and in the National Audit of End of Life Care. The Activities Coordinator, Eric Rankin, maintenance of the risk register for their As a result of this involvement, significant along with his team of recreational area of responsibility. Risks identified at changes have been made to the provision assistants, provided an extensive range local level, that are felt to be beyond the of end of life care. During 2010, the of social and recreational activities to control of the local managers, may be hospital’s multidisciplinary Hospice Friendly residents and patients during the year.

The Royal Hospital Donnybrook Annual Report & Accounts 2010 11 “ Staff maintained their usual high commitment to patients and continued to provide very high quality care throughout the year”

diseases and disorders. The podiatrist also offers education and advice to patients. As Type II Diabetes is increasing amongst the elderly population, podiatry provides an essential role in educating the patient about foot care and encouraging regular podiatric care. The Occupational Therapy department was relocated to more spacious facilities. An Activity of Daily Living Suite was Allied Health Services developed to facilitate the assessment of patients’ environmental and equipment It was another successful year for Allied resources including the latest electronic The Nutrition and Dietetics department needs in preparation for discharge from Health Services. Staff recruitment and voice output communication aids. As we greatly benefitted from the addition of one hospital. June saw the annual Patients’ Art retention issues were to the fore as we have a number of patients with swallowing temporary staff grade therapist and, as a and Pottery Exhibition take place. This was grappled with the HSE moratorium, difficulties, the department works closely direct result, waiting lists for all patient successfully hosted in conjunction with the career breaks, sickness, absence and with the multidisciplinary catering teams referrals have been reduced. The Annual General Meeting of the hospital maternity leave across the services. and also provides staff workshops on the department also developed a policy on and was a very enjoyable event. During Nevertheless, staff maintained their usual management of dysphagia. nutrition and guidelines on enteral feeding the year, upgrade and enlargement of the high commitment to patients and The Medical Social Work department which are now being followed in all wards. Seating Clinic was agreed and we look continued to provide very high quality continued to support patients and next of A high quality service is available forward to utilising this in 2011. care throughout the year. kin in relation to Fair Deal and the new throughout the hospital, prioritised The Speech and Language Therapy Nursing Home Support Scheme. Social according to clinical need. Education and Training department had a significant year of workers provide information to patients The Physiotherapy department moved All professions were involved in education re-establishment following a period of about appropriate placement, the into a more spacious location as a and training, both in-house and externally. high staff turnover. We now have a comprehensive assessment (CSAR) and consequence of the Occupational Therapy There is ongoing involvement in the dynamic team of two senior therapists, a the financial assessment required. The (OT) department moving to another part training of doctors as part of the UCD staff grade therapist and an assistant. The department also assisted with the of the hospital. This has allowed the Community Medicine module. service continues to make an impact across development of the Residential Care service to develop a quiet gym where Occupational Therapy and Physiotherapy the hospital, improving communication for Agreement and the review of HIQA therapists will provide more intensive services both have students on placement everyone. Towards the end of the year, standards. Notwithstanding staff changes one-to-one physiotherapy with patients. from Trinity College Dublin. All services the existing communication stations were throughout the year, the department The Podiatry service continued to also operate an in-service training upgraded and additional stations put in provided a comprehensive service to all provide a valuable service to patients with programme with many opportunities for place. We also purchased additional areas of the hospital. the diagnosis and treatment of foot multidisciplinary training. Learning from specialist courses is also shared throughout

12 The Royal Hospital Donnybrook Annual Report & Accounts 2010 “ Staff maintained their usual high commitment to patients and continued to provide very high quality care throughout the year”

diseases and disorders. The podiatrist also the hospital. Two senior staff are offers education and advice to patients. As completing masters programmes – in Type II Diabetes is increasing amongst the Healthcare Management and in Neurology elderly population, podiatry provides an and Gerontology. essential role in educating the patient Multidisciplinary working is a key feature about foot care and encouraging regular across all services. The professions podiatric care. welcome this and it enables excellent The Occupational Therapy department communication across all disciplines. was relocated to more spacious facilities. Although there have been challenges An Activity of Daily Living Suite was during the year, staff have, as ever, given of developed to facilitate the assessment of their best and retained the excellent patient patients’ environmental and equipment focus that has become our hallmark. The Nutrition and Dietetics department needs in preparation for discharge from greatly benefitted from the addition of one hospital. June saw the annual Patients’ Art temporary staff grade therapist and, as a and Pottery Exhibition take place. This was Heather G. Walsh | direct result, waiting lists for all patient successfully hosted in conjunction with the Allied Health Services Manager referrals have been reduced. The Annual General Meeting of the hospital department also developed a policy on and was a very enjoyable event. During nutrition and guidelines on enteral feeding the year, upgrade and enlargement of the which are now being followed in all wards. Seating Clinic was agreed and we look A high quality service is available forward to utilising this in 2011. throughout the hospital, prioritised according to clinical need. Education and Training The Physiotherapy department moved All professions were involved in education into a more spacious location as a and training, both in-house and externally. consequence of the Occupational Therapy There is ongoing involvement in the (OT) department moving to another part training of doctors as part of the UCD of the hospital. This has allowed the Community Medicine module. service to develop a quiet gym where Occupational Therapy and Physiotherapy therapists will provide more intensive services both have students on placement one-to-one physiotherapy with patients. from Trinity College Dublin. All services The Podiatry service continued to also operate an in-service training provide a valuable service to patients with programme with many opportunities for the diagnosis and treatment of foot multidisciplinary training. Learning from specialist courses is also shared throughout

The Royal Hospital Donnybrook Annual Report & Accounts 2010 13 “ Our Volunteer and Activities and Recreation Service work closely together to provide a varied programme of activities, with diversity and meeting individual needs at its core”

Education and Research Clinical research projects were undertaken throughout the year, demonstrating examples of good clinical practice and clinical excellence in the care of our complex continuing care residents. An analysis of the transfer of acutely unwell patients over a one year period to the Emergency Department in St. Vincent’s University Hospital for assessment showed Complex Continuing Care the appropriateness of patient transfer, and highlighted the prevention of many The Complex Continuing Care unit Clinical Service It is also an opportunity to discuss unwarranted acute hospital admissions. A continued to develop and enhance its & Training treatment options and preferences around study of residents who had suffered a service throughout 2010. The unit cares end of life care. stroke was undertaken to compare with a for older adults with complex medical The most important measure of what we Our Volunteer and Activities and recent Irish national stroke audit. The study nursing and multi-disciplinary care do relates to the quality of life of residents. Recreation Service work closely together to found that the proportion of residents needs. Our multidisciplinary team Central to the work of our clinicians and provide a varied programme of activities, who had suffered a stroke in our complex includes medical, nursing, carers is the assessment of progress with diversity and meeting individual needs continuing care facility was higher than physiotherapy, occupational therapy, through goal planning and maintenance of at its core. Both internal and external the national average. As a result, they had speech and language therapy, nutrition function informed by the most appropriate activities are available to residents. greater cognitive impairment, mobility and dietetics, podiatry and medical criteria available and delivered through The retention of committed and needs and communication difficulties. All social work. Residents were admitted to multidisciplinary teamwork. Standardised well-qualified staff at every level these residents had regular and structured the service under the Fair Deal Scheme. assessment scales for cognition, functional throughout the organisation is key to six weekly geriatrician-led multidisciplinary Pre-admission assessments were dependency, pain, nutrition, pressure ulcer our effectiveness, and there is continued reviews, compared with the national audit undertaken by the Medical Director and risk and falls risk are recorded and clinically investment in all aspects of education, sample where 68% had no formal review nursing staff to ensure that only reviewed. A scheduled interdisciplinary training and development of hospital mechanism. This paper was presented at clinically appropriate residents were clinical update meeting for family policies and procedures. Clinical training the European Geriatric Society meeting in accepted. members of residents is convened. This is programmes including phlebotomy, Dublin in June 2010. an important meeting to communicate cannulation, male catheterisation, In 2010, we also introduced a with family members and loved ones percutaneous endoscopic gastrostomy medication monitoring review, where a whose own experience and involvement in and tracheostomy tube replacement pharmacist, clinical nurse manager and the care pathway is crucial. are ongoing. senior doctor reviewed weekly psychotropic prescribing. This helped

14 The Royal Hospital Donnybrook Annual Report & Accounts 2010 “ Our Volunteer and Activities and Recreation Service work closely together to provide a varied programme of activities, with diversity and meeting individual needs at its core”

Education and Research reduce the medication burden among our a high standard and observed that RHD complex continuing care residents without staff members demonstrated a Clinical research projects were undertaken adverse consequences. The paper was commitment to the provision of quality, throughout the year, demonstrating presented at the European Geriatric person-centred care with a strong ethos of examples of good clinical practice and Society meeting in Dublin in June 2010. education and professional development. clinical excellence in the care of our The RHD Complex Continuing Care service complex continuing care residents. An also participated in the first national analysis of the transfer of acutely unwell prevalence study of antibiotic prescribing Dr Lisa Cogan | Medical Director patients over a one year period to the in Irish long-term care facilities. This is part Emergency Department in St. Vincent’s of a larger European study of 32 countries. University Hospital for assessment showed Due to our careful antibiotic stewardship the appropriateness of patient transfer, practices, antibiotic prescribing was far less and highlighted the prevention of many in the RHD compared with comparable It is also an opportunity to discuss unwarranted acute hospital admissions. A facilities, even though the level of co- treatment options and preferences around study of residents who had suffered a morbidity and complexity of our resident end of life care. stroke was undertaken to compare with a group was greater. Our Volunteer and Activities and recent Irish national stroke audit. The study In conjunction with St. Vincent’s Recreation Service work closely together to found that the proportion of residents University Hospital, we successfully provide a varied programme of activities, who had suffered a stroke in our complex hosted the “Dynamics of Quality Care” with diversity and meeting individual needs continuing care facility was higher than conference in April 2010. Multidisciplinary at its core. Both internal and external the national average. As a result, they had lectures covered end of life care, psychiatry activities are available to residents. greater cognitive impairment, mobility of old age, HIQA guidelines and topical The retention of committed and needs and communication difficulties. All issues relevant to nursing home care. well-qualified staff at every level these residents had regular and structured The conference was very well attended throughout the organisation is key to six weekly geriatrician-led multidisciplinary and promoted the enhanced care model our effectiveness, and there is continued reviews, compared with the national audit that exists for patients in complex investment in all aspects of education, sample where 68% had no formal review continuing care at the RHD. training and development of hospital mechanism. This paper was presented at In March 2010, we had an unannounced policies and procedures. Clinical training the European Geriatric Society meeting in HIQA inspection of the three complex programmes including phlebotomy, Dublin in June 2010. continuing care units (Cedars, Larches and cannulation, male catheterisation, In 2010, we also introduced a Oaks) against the National Quality percutaneous endoscopic gastrostomy medication monitoring review, where a Standards for Older people. The inspection and tracheostomy tube replacement pharmacist, clinical nurse manager and report stated that the medical and other are ongoing. senior doctor reviewed weekly healthcare needs of residents were met to psychotropic prescribing. This helped

The Royal Hospital Donnybrook Annual Report & Accounts 2010 15 p Figure 1: Admissions and Discharges Summary 2010

13 12 Total Admissions Total Discharges 11 10 9 8 7 6 5 4 3 2 1 0 RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE January February March April MayJuneJulyAugust September October November December General Rehabilitation p Figure 2: Patients Discharged Home 2010 14% Discharged The General Rehabilitation Unit continued provides a two weeks rehabilitation • Patient Satisfaction Not Home to deliver person-centred care to older ‘boost’ to older people in the community All patients discharged from the General persons, using a dynamic, progressive who require multidisciplinary review and Rehabilitation Unit are given a and goal orientated approach in 2010. The treatment, with the aim of improving questionnaire about the services provided aim of the service is to optimise each their ability to remain living at home for during their stay on the unit. Forms are 86% patient’s physical, sensory, intellectual, longer. The service also provides planned completed by the patients or with Discharged Home psychological and social well being. respite care for older people with assistance of friends or relatives. The The unit continues to experience an complex needs to assist the efforts of results of the patients’ satisfaction survey extensive spectrum of clinical pathologies, family and carers. were collated in November 2009 and May and prides itself in its interdisciplinary During 2010, there were a total of 122 2010 and presented in July 2010 to the dietitian. About 75% of patients received team approach. admissions and 125 discharges. These are senior management team at the General ongoing dietary intervention each month The interdisciplinary team approach has outlined by month in Figure 1 (opposite). Rehabilitation Unit service specific in 2010. The dietician works closely with also continued to provide a high quality The unit had an average bed occupancy meeting and reflected an overall positive nursing and household staff, patients service to older people with complex of 83% throughout the year, and 86% of feedback from patients and relatives. and relatives to ensure that therapeutic needs who are referred for rehabilitation patients admitted to the unit were diets are provided to patients. following acute hospital treatment, and successfully discharged to their own • Nutrition and Dietetics • Functional Independence Measure / to those referred directly from the home. The remaining 14% were enabled Nutrition and dietetics is integral to the Functional Assessment Measure community via the Day Hospital service. to transition to residential care as outlined rehabilitation process for all patients. (FIM/FAM) This contributes significantly to in Figure 2 (opposite). Every patient is screened for malnutrition preventing unnecessary prolonged acute During 2010, the interdisciplinary team within 24 hours of admission, and Introduced in the unit in January 2009, hospital stays and reduces the need for focussed on a number of service patients requiring intervention based on this has been ongoing and an audit was acute hospital admissions. The unit also developments including: their screening score are referred to the carried out to ensure best practice. The

16 The Royal Hospital Donnybrook Annual Report & Accounts 2010 p Figure 1: Admissions and Discharges Summary 2010

13 12 Total Admissions Total Discharges 11 10 9 8 7 6 5 4 3 2 1 0 RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE RESPITE January February March April MayJuneJulyAugust September October November December

p Figure 2: Patients Discharged Home 2010 audit concluded that this tool provides therapy and physiotherapy. There were an effective method of establishing and challenges with the recruitment of some 14% documenting realistic patient-centred disciplines to the multidisciplinary team Discharged goals. The functional independence in 2010, including medical social work, • Patient Satisfaction Not Home measure (FIM) is an outcome measure of speech and language therapy and All patients discharged from the General the severity of disability for an in-patient physiotherapy. Gaps in these areas have, Rehabilitation Unit are given a rehabilitation setting. FIM is specifically at times, resulted in the non-transfer of questionnaire about the services provided designed to address cognitive and some patients from St. Vincent’s during their stay on the unit. Forms are 86% psychosocial issues which are commonly University Hospital, but every effort was Discharged Home completed by the patients or with limiting factors for brain injured patients. made by the team to ensure service assistance of friends or relatives. The continuity and quality was maintained. results of the patients’ satisfaction survey • Interdisciplinary Education were collated in November 2009 and May During the year, staff continued to We look forward in 2011 to continuing 2010 and presented in July 2010 to the dietitian. About 75% of patients received attend in-house education sessions the delivery of comprehensive multi- senior management team at the General ongoing dietary intervention each month provided by the education co-ordinator, disciplinary rehabilitation to older people Rehabilitation Unit service specific in 2010. The dietician works closely with greatly enhancing the level of care with complex needs, and to developing our meeting and reflected an overall positive nursing and household staff, patients provided to patients. skills and knowledge in this increasingly feedback from patients and relatives. and relatives to ensure that therapeutic diets are provided to patients. relevant area of healthcare provision. • Student Education As part of the hospital’s quality agenda, • Nutrition and Dietetics we plan to audit and review nursing and • Functional Independence Measure / The team continued to work closely with Nutrition and dietetics is integral to the multidisciplinary team practices in 2011. Functional Assessment Measure universities, sharing their clinical rehabilitation process for all patients. (FIM/FAM) knowledge while offering a wide Every patient is screened for malnutrition Introduced in the unit in January 2009, number of student placements within 24 hours of admission, and Mary Mae Salomon | CNM2 this has been ongoing and an audit was throughout the year for undergraduate patients requiring intervention based on On behalf of the Rehabilitation Unit carried out to ensure best practice. The students in nursing, occupational their screening score are referred to the Multidisciplinary Team

The Royal Hospital Donnybrook Annual Report & Accounts 2010 17 “ We aspire to the highest standards in care and are pleased to be able to provide increased levels in speech and language therapy to those patients who face challenges post-stroke of communication deficits”

Stroke Rehabilitation

The Stroke Unit operates within an Our service and staffing levels currently patient experiences. Graded discharges The interdisciplinary team has continued interdisciplinary team model comprising meet the newly published standards in and facilitated time out for patients and to prioritise stroke education at all levels. medical staff, nursing, physiotherapy, stroke care set out by the Irish Heart families gives an accurate representation Staff nurses on the stroke unit attended occupational therapy, social work, speech Foundation in 2010. We aspire to the of patients’ care needs. This then facilitates the annual stroke conference in early and language therapy and dietetics. highest standards in care and are pleased a seamless transition to living at home. 2010. Our occupational therapist has Through interdisciplinary team assessment to be able to provide increased levels in The stroke team has built up successful completed further training in cognitive and rehabilitation, the unit facilitates speech and language therapy to those communication networks with community rehabilitation and our physiotherapist is service users to achieve their optimal patients who face challenges of services to assist in this often complex currently undertaking a masters degree in potential in physical, social and communication deficits post-stroke. We area. The average length of stay in the gerontology and neurology. psychological aspects of their well-being, were also able to avail of the support of stroke unit was 12 weeks. The overall We have maintained a successful ensuring dignity and respect at all times. the clinical neuro-psychology service in occupancy rate for 2010 was 82.75%. programme of education throughout The stroke team aims to provide a helping patients to adjust to life following The FIM/FAM (Functional Independence 2010 including: dedicated and comprehensive their stroke. Measure/Functional Assessment Measure) • Patient Education Sessions - each session rehabilitation service to people diagnosed It was a successful year in relation to tool is an ongoing standardised outcome was run by a different member of the with stroke and their families. Research functional outcomes for our patients’ measurement completed for each patient. team over a two-week period. shows that stroke patients do better when quality of life. In 2010, 44 patients were It measures the physical, functional, • A “Stroke Awareness for Carers” day. they are cared for by a dedicated team admitted and, of those, 36 were cognitive, language and emotional working closely to meet the patient’s successfully discharged home. This adjustments gained throughout the • In-service programme of education and individual goals. The Stroke Unit comprises represents an 85% return to community rehabilitation process. The team continues training for care assistants. two rooms with 12 beds, six female and living. The comprehensive nature of the to set standards for the completion of this We have welcomed feedback from all six male. The service is delivered in a discharge planning process within the unit assessment and regularly reviews the patients and their relatives in helping us bright, modern and pleasant environment. is key to these successful outcomes and outcomes achieved. maintain our patient-centred focus. We

18 The Royal Hospital Donnybrook Annual Report & Accounts 2010 “ We aspire to the highest standards in care and are pleased to be able to provide increased levels in speech and language therapy to those patients who face challenges post-stroke of communication deficits”

patient experiences. Graded discharges The interdisciplinary team has continued have been delighted with the positive and facilitated time out for patients and to prioritise stroke education at all levels. feedback and constructive suggestions families gives an accurate representation Staff nurses on the stroke unit attended made through our patient satisfaction of patients’ care needs. This then facilitates the annual stroke conference in early survey. Quality of patient care and a seamless transition to living at home. 2010. Our occupational therapist has successful functional outcomes remains The stroke team has built up successful completed further training in cognitive crucial to the philosophy of the Stroke Unit. communication networks with community rehabilitation and our physiotherapist is services to assist in this often complex currently undertaking a masters degree in area. The average length of stay in the gerontology and neurology. Emer Kennedy | CNM2 stroke unit was 12 weeks. The overall We have maintained a successful Jo Cannon | Occupational Therapist Stroke Unit occupancy rate for 2010 was 82.75%. programme of education throughout The FIM/FAM (Functional Independence 2010 including: Measure/Functional Assessment Measure) • Patient Education Sessions - each session tool is an ongoing standardised outcome was run by a different member of the measurement completed for each patient. team over a two-week period. It measures the physical, functional, • A “Stroke Awareness for Carers” day. cognitive, language and emotional adjustments gained throughout the • In-service programme of education and rehabilitation process. The team continues training for care assistants. to set standards for the completion of this We have welcomed feedback from all assessment and regularly reviews the patients and their relatives in helping us outcomes achieved. maintain our patient-centred focus. We

The Royal Hospital Donnybrook Annual Report & Accounts 2010 19 “ Respite services continue to be provided for a growing number of patients from the community”

Patients’ meetings continued to play an important role on the Maples Unit. Facilitated by nursing and social work, they are held every six weeks approximately, and enable the patients and staff to address any issues that may arise. The Transition Lodge continued to be a valuable resource to the unit and, during the year, several patients were able to spend quality time with their families away Adult Disability (Maples Unit) from the ward, both during the day and on overnight stays. The lodge also enables For the last 10 years, the Maples Unit Six of the 28 beds are now dedicated from the unit and avail of the four weeks patients to practice their day-to-day skills (formerly known as the Adult Disability to slow stream rehabilitation, with the offered per year. in a homely environment. Unit) has provided a dedicated service for majority of that patient group being During 2010, the Maples team adapted Many challenges faced the Maples patients between the ages of 18-65 years referred to us from St. Vincent’s University the Rivermead Goal Planning structure for Unit during 2010. One which impacted with complex medical, neurological and Hospital, the Mater Misericordiae Hospital patients admitted for slow stream on patients is the lack of funding in the physical disabilities. It provides services for and the National Rehabilitation Hospital rehabilitation. This has enabled individual community, which made it difficult to adults with a chronic disability due to (NRH), Dun Laoghaire. A further five beds treatment plans to be more patient facilitate their discharge home. Due to conditions that do not require ongoing have been reserved for patients with focused. The FIM/FAM assessment tool the economic climate, funding for care specialist rehabilitation medicine input. disorders of consciousness and neuro- continues to facilitate more accurate goal packages has been reduced. Some of the In line with hospital strategy, there is an palliative conditions. Two patients planning on admission. This tool has been community care teams have now set up increased emphasis on rehabilitation as completed the Sensory Modality audited and the results are being evaluated. waiting lists for these care packages, well as providing continuing care for more Assessment and Rehabilitation Technique Medical and nursing ward rounds were further extending delayed discharges complex conditions. During 2010, the (SMART) programme in the NRH, and introduced twice a month on the unit. This from the unit. Despite this, however, team defined the service to enhance the are continuing with their treatment has provided the patients with an nine patients were discharged from the structure and direction of treatments plans here. opportunity to meet with the doctors and Maples Unit. Six have been discharged provided in line with hospital strategy and Respite services continue to be provided their team on a more structured basis, and successfully back to their communities, discussions with the HSE. The team also for a growing number of patients from has contributed to continuity of care. The one was discharged to a more suitable revised the admission and discharge the community and two beds are multidisciplinary team also contributed to facility, and two were transferred to our criteria for the unit, and is currently in the dedicated to this. Due to resource a benchmarking survey on the disorders of Phoenix Unit for more intensive process of drawing up an operational constraints, input is currently limited to consciousness, led by Dr. Delargy in the rehabilitation. We expect the throughput policy, which will outline our ethos and medical and nursing staff. Some of these NRH. We look forward to continuing to in the unit to increase as the changes orientate outside agencies to our services. patients were previously discharged home work with this group in the future. introduced during 2010 bed in.

20 The Royal Hospital Donnybrook Annual Report & Accounts 2010 “ Respite services continue to be provided for a growing number of patients from the community”

Patients’ meetings continued to play an In spite of all the difficulties, the team important role on the Maples Unit. worked very well together, concentrating Facilitated by nursing and social work, they on re-enabling and empowering the are held every six weeks approximately, patients on the Maples Unit. Our aim is and enable the patients and staff to to facilitate the smooth transition from address any issues that may arise. hospital to community for those who The Transition Lodge continued to be a wish to return to independent living, and valuable resource to the unit and, during to provide a meaningful quality of life to the year, several patients were able to patients who require our in-patient spend quality time with their families away services. This is achieved by the from the ward, both during the day and multidisciplinary team in conjunction with on overnight stays. The lodge also enables the activities co-coordinator, the volunteer from the unit and avail of the four weeks patients to practice their day-to-day skills co-coordinator and their teams. We look offered per year. in a homely environment. forward to continuing to work together During 2010, the Maples team adapted Many challenges faced the Maples and facing all the challenges that 2011 the Rivermead Goal Planning structure for Unit during 2010. One which impacted will bring. patients admitted for slow stream on patients is the lack of funding in the rehabilitation. This has enabled individual community, which made it difficult to treatment plans to be more patient facilitate their discharge home. Due to Elaine Foley | CNM2 focused. The FIM/FAM assessment tool the economic climate, funding for care On behalf of the Multidisciplinary Team continues to facilitate more accurate goal packages has been reduced. Some of the planning on admission. This tool has been community care teams have now set up audited and the results are being evaluated. waiting lists for these care packages, Medical and nursing ward rounds were further extending delayed discharges introduced twice a month on the unit. This from the unit. Despite this, however, has provided the patients with an nine patients were discharged from the opportunity to meet with the doctors and Maples Unit. Six have been discharged their team on a more structured basis, and successfully back to their communities, has contributed to continuity of care. The one was discharged to a more suitable multidisciplinary team also contributed to facility, and two were transferred to our a benchmarking survey on the disorders of Phoenix Unit for more intensive consciousness, led by Dr. Delargy in the rehabilitation. We expect the throughput NRH. We look forward to continuing to in the unit to increase as the changes work with this group in the future. introduced during 2010 bed in.

The Royal Hospital Donnybrook Annual Report & Accounts 2010 21 “ The enhancement of the spasticity service by the addition of ultrasound guided procedures has enabled the service to improve the accuracy of procedures”

measurement and the data collected will be analysed and available for the 2011 report. There were also significant improvements in the nutrition and dietetics department with the welcome addition of a dedicated therapist. This meant that all patients referred to this department were assessed and advised during 2010 within 24 - 48 hours of referral. This was Phoenix Unit a major improvement. Other Strategic Despite the current economic climate and Strategic Developments • communication – especially when things Developments the staff moratorium, the Phoenix Unit are not going smoothly. As part of the Phoenix team’s commitment Dr. Áine Carroll is a member of the Irish continued to provide a high quality service. to the delivery of quality care, it had a Working groups were established to Heart Foundation Council on Stroke. She During 2010, we provided rehabilitation facilitated away day which focussed on work on the various action points and is also currently on a working group for the across the spectrum of neurological effective team building through improving most are nearing completion. development of a national strategy for disorders, including acquired brain injury, communication, enhancing leadership skills, In 2011, there will be three services rehabilitation, the results of which should multiple sclerosis, spasticity, stroke, cerebral promoting creativity & thinking outside of offered within Phoenix with a clear be published later this year. Implementation aneurysms, encephalitides, brain and spinal the box, and change management. admission and discharge criteria and scope of strategy has been included in the HSE vascular malformations, muscle diseases, A number of issues were identified and of service. These are needs assessment, strategy for 2011. peripheral neuropathy, spinal cord injury, a number of actions proposed, including: therapeutic reassessment, and continuing Dr. Carroll is also on a working group anoxic brain injury and cerebral palsy. neurological rehabilitation. • redefine scope of service admission/ for the development of the Stroke It is anticipated that occupancy levels of discharge; admission/discharge process; Programme of the Directorate of Quality Advances in Technology 85% (international norm to accommodate and Clinical Care (DQCC), which will also • shared commitment to planning and Hardly a month passes without the advent infection control/complex case mix/ form part of the HSE Strategic Plan for implementation; of some new medical advance and the behavioural issues) will be achieved. 2011, and she is the national clinical lead Phoenix Unit endeavours to implement • engage with key influencers to affect Phoenix Unit strongly supports for the Rehabilitation Medicine some of these techniques. The decision making around resources; continuous measurement and transparent Programme of the DQCC. enhancement of the spasticity service by training review and evaluation; reporting of clinical outcomes, in the belief the addition of ultrasound guided • clarifying and making visible our overall that making accurate information available procedures has enabled the service to ethos and goals, and to patients and commissioners will result in improve the accuracy of procedures. better healthcare decisions. To this end, the unit employs the FIM/FAM outcome

22 The Royal Hospital Donnybrook Annual Report & Accounts 2010 “ The enhancement of the spasticity service by the addition of ultrasound guided procedures has enabled the service to improve the accuracy of procedures”

measurement and the data collected will be Education on “Disorders of consciousness and analysed and available for the 2011 report. misdiagnosis, a retrospective review in Diploma in Stroke Medicine There were also significant a National Rehabilitation Hospital” to Dr. Carroll is on the Exam Steering improvements in the nutrition and dietetics the annual meeting of the Irish Association Committee for the Diploma in department with the welcome addition of of Rehabilitation Medicine in Dublin. Cerebrovascular & Stroke Medicine. a dedicated therapist. This meant that all patients referred to this department Publications included: Academic Activity were assessed and advised during 2010 Presentations: In May, Dr. Carroll made a • “The need to develop a network of within 24 - 48 hours of referral. This was presentation on the Medical Consequences specialist neuro-rehabilitation services a major improvement. of Speed, at an international conference in Ireland” by Dr. Áine Carroll in “The on speeding, in Dublin Castle. Future for Neurological Conditions in Other Strategic Guest Speaker: Dr. Carroll undertook a Ireland: A Challenge for Healthcare; • communication – especially when things Developments number of guest speaker presentations, an Opportunity for Change” for the are not going smoothly. Neurological Alliance of Ireland, and Dr. Áine Carroll is a member of the Irish including: Working groups were established to Heart Foundation Council on Stroke. She • The Medical Management of • “Needs assessment for cerebral palsy work on the various action points and is also currently on a working group for the Sialorrhoea (Irish Society for Disability service provision in Ireland as part of the most are nearing completion. development of a national strategy for and Rural Health, Crowne Plaza Hotel, National Rehabilitation Strategy Clinical In 2011, there will be three services rehabilitation, the results of which should Dublin, in June); Rehabilitation, 2010” by McDonagh C. offered within Phoenix with a clear and Carroll Á. be published later this year. Implementation • MS and Rehab in Ireland; where are we admission and discharge criteria and scope of strategy has been included in the HSE now and where would we like to be? of service. These are needs assessment, I wish to thank all those who support strategy for 2011. (Neurological Information Day, Dublin, in therapeutic reassessment, and continuing us every day - volunteers, employees, Dr. Carroll is also on a working group September) and, in the same month, neurological rehabilitation. for the development of the Stroke management and the hospital board, It is anticipated that occupancy levels of • Dr. Carroll was guest speaker with but especially Mary Bennett, Medical Programme of the Directorate of Quality Dr. Brian McGlone on “Botulinum 85% (international norm to accommodate and Clinical Care (DQCC), which will also Administrator. Together, we make a infection control/complex case mix/ toxin in the management of sialorrhoea great impact on the quality of life of form part of the HSE Strategic Plan for in acquired brain injury, a case series” behavioural issues) will be achieved. 2011, and she is the national clinical lead the patients we serve. Phoenix Unit strongly supports (the Irish Association of Rehabilitation for the Rehabilitation Medicine Medicine annual meeting, Dublin). continuous measurement and transparent Programme of the DQCC. reporting of clinical outcomes, in the belief Also in September, Dr. Carroll, Dr. Áine Carroll | that making accurate information available Dr. Jacqueline Stowe, Dr. Alison McCann, Consultant in Rehabilitation Medicine to patients and commissioners will result in Dr. Jacinta McElligott, Dr. Mark Delargy, better healthcare decisions. To this end, the Dr. Jacinta Morgan, Dr. Aisling Weyham unit employs the FIM/FAM outcome and Dr. Aneesa Ally made a presentation

The Royal Hospital Donnybrook Annual Report & Accounts 2010 23 “ We have several patients who otherwise would be in nursing homes or acute hospitals if Day Hospital support was not in place”

Day Hospital

The Day Hospital provides an essential this trend in 2011 by raising awareness in • Advising family on appropriate assessments in both the Day Hospital and service to the community by enabling the community of the invaluable service compensatory strategies to allow in patients’ homes. This was extremely people to remain living safely in their own that this facility provides. changing needs to be managed helpful in creating an individualised homes for longer, and by reducing acute We have an established multidisciplinary at home. rehabilitation plan for each person that hospital admissions. The aim of this team of nurses and allied healthcare • Undertaking minor adaptations to attends the Day Hospital and facilitated service is to promote a person’s professionals who have been with the patients’ homes. the development of integrated care for the independence, health and overall well- service for a number of years. patient. • Supporting families and carers as they being. The service is delivered by a The increasing complexity of patients’ We have a waiting list of up to eight come to terms with changing physical multidisciplinary team committed to needs, together with their desire to remain weeks, which reflects the increasing and social dependence levels. rehabilitation, health education and at home for as long as possible, has demand for, and awareness of, our service empowerment of service users. increased pressure on family and carer • Close liaison with our multidisciplinary amongst clinicians and in the local The number of patients attending the support. As a result, we are finding community colleagues, and care givers. population. In 2011, we aim to deliver a Day Hospital increased during 2010 to ourselves becoming increasingly part of • Appropriate onward referral targeted stroke out-patient service and a 397. They attended a total of 4,325 times essential home support networks. We have where indicated. structured falls clinic. - an increase of 18% on 2009. There were several patients who otherwise would be A number of afternoons in the Day 171 new admissions to the Day Hospital in nursing homes or acute hospitals if Day Hospital were dedicated to education during the year – a 6% increase on 2009 Hospital support was not in place. We sessions on subjects such as safety in the Emer Kennedy | Clinical Nurse Manager referral levels. have achieved this through: home and personal well-being. Paul Diamond | Occupational Therapist Some patients require attendance at the • Monitoring physical and cognitive levels During 2010, the team continued to Day Hospital more frequently than once a and intervening in a timely fashion. build on the previously established week and we have tailored the service to • Optimising and maintaining balance, relationship with our multidisciplinary team meet their needs. We hope to maintain gait, and cognitive/functional abilities. community colleagues, with joint

24 The Royal Hospital Donnybrook Annual Report & Accounts 2010 “ We have several patients who otherwise would be in nursing homes or acute hospitals if Day Hospital support was not in place”

• Advising family on appropriate assessments in both the Day Hospital and compensatory strategies to allow in patients’ homes. This was extremely changing needs to be managed helpful in creating an individualised at home. rehabilitation plan for each person that • Undertaking minor adaptations to attends the Day Hospital and facilitated patients’ homes. the development of integrated care for the patient. • Supporting families and carers as they We have a waiting list of up to eight come to terms with changing physical weeks, which reflects the increasing and social dependence levels. demand for, and awareness of, our service • Close liaison with our multidisciplinary amongst clinicians and in the local community colleagues, and care givers. population. In 2011, we aim to deliver a • Appropriate onward referral targeted stroke out-patient service and a where indicated. structured falls clinic. A number of afternoons in the Day Hospital were dedicated to education sessions on subjects such as safety in the Emer Kennedy | Clinical Nurse Manager home and personal well-being. Paul Diamond | Occupational Therapist During 2010, the team continued to build on the previously established relationship with our multidisciplinary team community colleagues, with joint

The Royal Hospital Donnybrook Annual Report & Accounts 2010 25 “ We have received approval for all of our applications for replacement of staff in the category of ‘delegated sanction posts’”

Human Resources

The moratorium on staff recruitment, three from General Services and three maintaining the generally stable industrial During the year, we participated in a imposed by the Health Services Executive from Administration. As a result of their relations environment that they contributed research project involving the University in 2009, remained in place and created departure, we commenced 2011 with to during their time with the hospital. of Strasbourg on the challenges many challenges to maintaining our quality restructuring in these areas. As with all In general, industrial relations matters encountered due to increasing patient and standard of care in 2010. We have change, there will be challenges and we arising were dealt with locally without diversity in the health service. We look received approval for all of our applications look forward to the ongoing co-operation referral to the Labour Court. forward to learning the outcome of the for replacement of staff in the category of of our staff, whose support for changes to The terms of the Croke Park Agreement project during the coming year. “delegated sanction posts”. They are date has been greatly appreciated. have given support to our ongoing efforts medical social workers, physiotherapists, During 2010, we said goodbye to to reduce costs and create efficiencies Policy Development occupational therapists, and speech and members of staff whose length of service within the hospital. We are continuing to update policies to language therapists. at the hospital ranged from one to 39 ensure that we are in compliance with all We also received some approvals for years. I’d like to take this opportunity to Training & Education relevant employment legislation. replacement of staff leaving “non thank each of them for their dedicated Despite budgetary cuts, we managed to delegated sanction posts”, but the service to the hospital and wish them maintain a good standard of staff training Administration requirement to suppress two posts in well for the future. and education. Once again, our ongoing Ongoing development of our StaffCare order to fill one vacancy creates commitment to staff training enjoyed personnel information system means that difficulties, particularly as we continued to Industrial Relations successes, with several of our care attendance reports for all staff can now be operate within the staff complement A special thank you and best wishes go to assistants successfully completing FETAC produced automatically. We are currently sanctioned by the HSE. our IMPACT and SIPTU trade union level 5 courses. Our congratulations to developing the training and education The announcement of a voluntary representatives who left during the year, them for their achievements and our database and hope to be able to issue redundancy scheme at the end of 2010 led and who were both long serving members thanks to their colleagues for supporting automatic reminders to staff when their to the departure of six members of staff; of our staff. We look forward to them through their studies. statutory training is due for renewal.

26 The Royal Hospital Donnybrook Annual Report & Accounts 2010 “ We have received approval for all of our applications for replacement of staff in the category of ‘delegated sanction posts’”

maintaining the generally stable industrial During the year, we participated in a In 2010, we were required to submit relations environment that they contributed research project involving the University monthly absenteeism percentages to the to during their time with the hospital. of Strasbourg on the challenges National Employment Monitoring Unit of In general, industrial relations matters encountered due to increasing patient the HSE so that we can be benchmarked arising were dealt with locally without diversity in the health service. We look with similar organisations. To date, our referral to the Labour Court. forward to learning the outcome of the percentage absenteeism compares The terms of the Croke Park Agreement project during the coming year. favourably with other organisations and have given support to our ongoing efforts we look forward to maintaining and to reduce costs and create efficiencies Policy Development improving the levels with the support of within the hospital. We are continuing to update policies to our staff and line managers. ensure that we are in compliance with all Training & Education relevant employment legislation. Despite budgetary cuts, we managed to Mary Hansell | Human Resources Manager maintain a good standard of staff training Administration and education. Once again, our ongoing Ongoing development of our StaffCare commitment to staff training enjoyed personnel information system means that successes, with several of our care attendance reports for all staff can now be assistants successfully completing FETAC produced automatically. We are currently level 5 courses. Our congratulations to developing the training and education them for their achievements and our database and hope to be able to issue thanks to their colleagues for supporting automatic reminders to staff when their them through their studies. statutory training is due for renewal.

The Royal Hospital Donnybrook Annual Report & Accounts 2010 27 p Figure 3: Five Year Financial History 25 ■ 2010 ■ 2009 20 ■ 2008 ■ 2007 15 ■ 2006

10

5

0 Financial Controller’s Report Allocation Income Pay Non-Pay

For the year ended 31st December 2010, figure by €1,883,912 (10%) and Non-pay and Renovations (€58,996). All of the p Figure 4: Analysis of Pay Costs the hospital recorded a surplus of expenditure increased by €119,678 (2%). additional expenditure was deemed €232,158 compared with a small deficit The decrease in Pay expenditure relates necessary in order to maintain the 6% of €14,668 in 2009. With the allocation to the decision to keep beds closed in high quality of standards throughout 9% 4% for 2010 being cut, the management order to stay within the reduced allocation the hospital. 11% sought to effect significant cost from the HSE. In addition, the hospital was It should be noted that in 2009 there reductions during the year across the not able to recruit replacement nursing was additional expenditure on 10% board, some of which were in anticipation staff for those who retired during the year Maintenance and Renovations to carry out of further cuts expected in the allocation or to fill other posts which arose as a result essential maintenance work to ensure 60% for 2011 – an anticipation since realised. of maternity or paternal leave. The hospital relevant areas were HIQA (Health The surplus of €232,158 arose as a had 70 beds closed at the end of 2010. Information Quality Authority) compliant consequence of these focused cost The increase of €119,678 (2%) in and to ensure health and safety cutting efforts which will stand to the Non-pay expenditure is reflected in the requirements were met. ■ Nursing & Allied hospital and ensure the viability of service increase in areas such as Catering & The total income for the year amounted ■ delivery in 2011 and beyond. Hardware (€46,546) and for Furniture, to €22,072,328, a decrease of Catering & Housekeeping The overall cost of running the hospital Crockery & Hardware (€99,188), both of €1,517,408 (6%) on the 2009 figure. The ■ Administration in 2010 was €21,840,170. This is a which relate mainly to the canteen and hospital’s allocation from the HSE ■ Paramedical decrease of €1,764,234 (7%) on 2009. coffee shop refurbishment. Other decreased by €1,315,552 (6%) from the ■ Pensions € Of these overall costs, Pay expenditure Professional Services have increased by 2009 figure of 21,208,271. ■ Other accounted for €16,553,249 (76%) and €147,466. Offsetting these increases are The hospital was not as significantly Non-pay expenditure €5,286,921 (24%). reductions in Medical and Surgical impacted in 2010 (€422,563) as it had Pay expenditure decreased from the 2009 Supplies (€52,093) and Maintenance been in 2009 (€802,394) by the once off

28 The Royal Hospital Donnybrook Annual Report & Accounts 2010 p Figure 3: Five Year Financial History 25 ■ 2010 ■ 2009 20 ■ 2008 ■ 2007 15 ■ 2006

10

5

0 Allocation Income Pay Non-Pay

and Renovations (€58,996). All of the p Figure 4: Analysis of Pay Costs pension payments on staff retirement. voluntary gifts and donations. We are, as additional expenditure was deemed However, the ongoing annual pension always, most appreciative of all receipts, necessary in order to maintain the 6% payments in 2010 (€1,141,346) increased which have largely been committed to high quality of standards throughout 9% 4% by €189,762 on the 2009 figure capital development projects. In 2010, the hospital. 11% (€951,584). voluntary gifts, donations and bequests It should be noted that in 2009 there Ordinary Income, excluding the funds amounted to €115,840. was additional expenditure on 10% collected from the pension levy, has As was the case in the previous eight Maintenance and Renovations to carry out decreased by €317,207 (18%) on the years, the independent auditor’s report on essential maintenance work to ensure 60% 2009 figure. This decrease mainly relates the hospital’s financial statements includes relevant areas were HIQA (Health to a reduction of €192,304 in patient a technical qualification on the basis that Information Quality Authority) compliant maintenance income. It should be noted “The financial statements do not include and to ensure health and safety that the 2009 patient income figure pension liabilities and pension assets as € requirements were met. ■ Nursing & Allied included 132,311 relating to the required by Financial Reporting Standard The total income for the year amounted insurance proceeds from a road 17 “Retirement Benefits”.” ■ to €22,072,328, a decrease of Catering & Housekeeping traffic accident. The hospital has not included pension €1,517,408 (6%) on the 2009 figure. The ■ Administration The Special Fund Account for the year liabilities and pension assets for the hospital’s allocation from the HSE ■ Paramedical shows a surplus of income over following reasons: the pension and lump decreased by €1,315,552 (6%) from the ■ Pensions expenditure of €154,374, which increases sum costs of the VHSS have always been € 2009 figure of 21,208,271. ■ Other the accumulated reserve being carried recognised as being funded out of, and The hospital was not as significantly forward into 2011 to €3,433,016. As in allowed for in, the annual revenue impacted in 2010 (€422,563) as it had previous years, the hospital’s Special Fund allocation received from the Department been in 2009 (€802,394) by the once off Account continues to rely heavily on of Health and Children, now via the Health

The Royal Hospital Donnybrook Annual Report & Accounts 2010 29 Service Executive. On this basis, the Information the patient administration system (iCare) re-floored and new bookcases were hospital is of the opinion that the VHSS, to provide key performance indicators in a installed in the reading room. and not the hospital, has the liability for Communications timely and efficient manner. Automatic controls were fitted to all the costs. In light of this, we feel unable to Technology We also continued to work with the single rooms to assist patient access. New justify the not insignificant cost associated The Information Communications Medical Director to develop the use of automatic doors were also installed to the with having the required valuation carried Technology (ICT) department services all modern technology through linking with Oratory and Day Hospital entrance. The out when the funds involved could areas and departments within the hospital St. Vincent’s University Hospital to gain main concourse area had new fire screens otherwise be used for patient care. and in 2010 it continued to develop the faster and more timely access to the installed, enhancing its overall appearance. During 2007, the hospital appointed a infrastructure and service quality. results of certain diagnostic procedures. All corridors were redecorated. firm of chartered accountants to provide The main services provided by the The new staff library was created and internal audit services. The internal department were hardware and software General Services fitted out. The physiotherapy and auditors have reported they reviewed the support, upgrades and purchases, occupational therapy departments were During 2010, the department faced effectiveness of the system of internal security for the network, data & completely redecorated and re-floored. significant challenges and marked a control in 2010. This review was hardware and training. Works also started on the new seating number of achievements. performed through the implementation of During the year, we developed an clinic and waste yard. The administration Laundry was upgraded in line with HIQA an agreed internal audit plan. The internal information point in the main concourse offices were redecorated and re-floored. standards and the main kitchen received a auditors have confirmed there were no to give patients, residents, relatives, staff Bushfield House became vacant and has new resin floor throughout, which also significant issues arising from this review. and visitors free access to all hospital been decommissioned. Additional CCTV included a total refurbishment of the policies and the hospital’s website. The cameras were purchased for new dining room and snack bar. The main coverage provided by the closed wireless developments. kitchen also received a new supply board. network was extended to improve access The adverse weather conditions hit us The reading room and the residents’ and we continued to work on developing hard in 2010 though we were more computer room were redecorated and

30 The Royal Hospital Donnybrook Annual Report & Accounts 2010 the patient administration system (iCare) re-floored and new bookcases were prepared than in 2009, with larger salt and to provide key performance indicators in a installed in the reading room. grit stocks in place. A big thank you to our timely and efficient manner. Automatic controls were fitted to all contracted grounds men who dug out and We also continued to work with the single rooms to assist patient access. New gritted during the bad weather. Medical Director to develop the use of automatic doors were also installed to the In order to continually seek efficiencies modern technology through linking with Oratory and Day Hospital entrance. The again this year, we have looked at all St. Vincent’s University Hospital to gain main concourse area had new fire screens maintenance contracts to achieve savings. faster and more timely access to the installed, enhancing its overall appearance. The dedication of all staff within the results of certain diagnostic procedures. All corridors were redecorated. department has made 2010 another The new staff library was created and successful year and we look forward to General Services fitted out. The physiotherapy and finishing off work in progress, such as the occupational therapy departments were waste yard, in 2011. During 2010, the department faced completely redecorated and re-floored. significant challenges and marked a Works also started on the new seating number of achievements. clinic and waste yard. The administration Paul Flood | Laundry was upgraded in line with HIQA offices were redecorated and re-floored. Financial Controller standards and the main kitchen received a Bushfield House became vacant and has new resin floor throughout, which also been decommissioned. Additional CCTV included a total refurbishment of the cameras were purchased for new dining room and snack bar. The main developments. kitchen also received a new supply board. The adverse weather conditions hit us The reading room and the residents’ hard in 2010 though we were more computer room were redecorated and

The Royal Hospital Donnybrook Annual Report & Accounts 2010 31 The Royal Hospital Donnybrook Financial Statements Year Ended 31 December 2010

i The Royal Hospital Donnybrook Annual Report & Accounts 2010 The Royal Hospital Donnybrook Financial Statements Year Ended 31 December 2010

Contents Page

Independent Auditors’ Report iii - iv

Accounting Policies v

Ordinary Income And Expenditure Account vi

Ordinary Balance Sheet vii

Special Fund Account viii

Special Fund Balance Sheet ix

Cash Flow Statement x

Notes To The Financial Statements xi - xv

The Royal Hospital Donnybrook Annual Report & Accounts 2010 ii PricewaterhouseCoopers One Spencer Dock, North Wall Quay, Dublin 1, Ireland

Telephone +353 (0) 1 792 6000 Facsimile +353 (0) 1 792 6200 I.D.E. Box No. 137 Internet www.pwc.com/ie

Independent auditors’ report to the Governors of The Royal Hospital Donnybrook Independent auditors’ report to the Governors of The Royal Hospital Donnybrook - continued

We have audited the financial statements on pages V to XV. These financial statements have been prepared under the accounting Adverse opinion policies set out therein in the statement of accounting policies on page V. The financial statements do not include pension liabilities and pension assets as required by Financial Reporting Standard 17 Respective responsibilities of the Board of Management and auditors ‘Retirement Benefits’. The Board of Management’s responsibilities for preparing the financial statements in accordance with applicable Irish law and In view of the non-inclusion of pension liabilities and pension assets referred to above, in our opinion, the financial statements do accounting standards issued by the Accounting Standards Board and published by the Institute of Chartered Accountants in Ireland not give a true and fair view, in accordance with Generally Accepted Accounting Practice in Ireland, of the state of the hospital’s (Generally Accepted Accounting Practice in Ireland) are set out in the Statement of Responsibilities of the Board of Management on affairs as at 31 December 2010 and of its net income or expenditure for the year then ended. page XI. The financial statements give a true and fair view of the cash flows of the hospital for the year ended 31 December 2010. Our responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International We have obtained all the information and explanations we consider necessary for the purposes of our audit. In our opinion, proper Standards on Auditing (UK and Ireland). This report, including the opinion, has been prepared for and only for the Governors books of account have been kept by the hospital. The financial statements are in agreement with the books of account. as a body and for no other purpose. We do not, in giving this opinion, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing. We report to you our opinion as to whether the financial statements give a true and fair view, in accordance with Generally PricewaterhouseCoopers Accepted Accounting Practice in Ireland. We state whether we have obtained all the information and explanations we consider necessary for the purposes of our audit and whether the financial statements are in agreement with the books of account. Chartered Accountants and Registered Auditors We also report to you our opinion as to whether the hospital has kept proper books of account. Dublin 28 April 2011 Basis of audit opinion We conducted our audit in accordance with International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements. It also includes an assessment of the significant estimates and judgements made by the Board of Management in the preparation of the financial statements, and of whether the accounting policies are appropriate to the hospital’s circumstances, consistently applied and adequately disclosed. We planned and performed our audit so as to obtain all the information and explanations which we considered necessary in order to provide us with sufficient evidence to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error. In forming our opinion we also evaluated the overall adequacy of the presentation of information in the financial statements.

iii The Royal Hospital Donnybrook Annual Report & Accounts 2010 PricewaterhouseCoopers One Spencer Dock, North Wall Quay, Dublin 1, Ireland

Telephone +353 (0) 1 792 6000 Facsimile +353 (0) 1 792 6200 I.D.E. Box No. 137 Internet www.pwc.com/ie

Independent auditors’ report to the Governors of The Royal Hospital Donnybrook Independent auditors’ report to the Governors of The Royal Hospital Donnybrook - continued

We have audited the financial statements on pages V to XV. These financial statements have been prepared under the accounting Adverse opinion policies set out therein in the statement of accounting policies on page V. The financial statements do not include pension liabilities and pension assets as required by Financial Reporting Standard 17 Respective responsibilities of the Board of Management and auditors ‘Retirement Benefits’. The Board of Management’s responsibilities for preparing the financial statements in accordance with applicable Irish law and In view of the non-inclusion of pension liabilities and pension assets referred to above, in our opinion, the financial statements do accounting standards issued by the Accounting Standards Board and published by the Institute of Chartered Accountants in Ireland not give a true and fair view, in accordance with Generally Accepted Accounting Practice in Ireland, of the state of the hospital’s (Generally Accepted Accounting Practice in Ireland) are set out in the Statement of Responsibilities of the Board of Management on affairs as at 31 December 2010 and of its net income or expenditure for the year then ended. page XI. The financial statements give a true and fair view of the cash flows of the hospital for the year ended 31 December 2010. Our responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International We have obtained all the information and explanations we consider necessary for the purposes of our audit. In our opinion, proper Standards on Auditing (UK and Ireland). This report, including the opinion, has been prepared for and only for the Governors books of account have been kept by the hospital. The financial statements are in agreement with the books of account. as a body and for no other purpose. We do not, in giving this opinion, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing. We report to you our opinion as to whether the financial statements give a true and fair view, in accordance with Generally PricewaterhouseCoopers Accepted Accounting Practice in Ireland. We state whether we have obtained all the information and explanations we consider necessary for the purposes of our audit and whether the financial statements are in agreement with the books of account. Chartered Accountants and Registered Auditors We also report to you our opinion as to whether the hospital has kept proper books of account. Dublin 28 April 2011 Basis of audit opinion We conducted our audit in accordance with International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements. It also includes an assessment of the significant estimates and judgements made by the Board of Management in the preparation of the financial statements, and of whether the accounting policies are appropriate to the hospital’s circumstances, consistently applied and adequately disclosed. We planned and performed our audit so as to obtain all the information and explanations which we considered necessary in order to provide us with sufficient evidence to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error. In forming our opinion we also evaluated the overall adequacy of the presentation of information in the financial statements.

The Royal Hospital Donnybrook Annual Report & Accounts 2010 iv Accounting Policies Ordinary Income and Expenditure Account Year Ended 31 December 2010

The significant accounting policies adopted by the hospital are Pensions 2010 2009 as follows: The liability in respect of pensions payable is underwritten by Notes € € the Minister for Health and Children and the net cost of Historical cost convention Revenue pensions is included in the annual allocation towards net The financial statements are prepared under the historical expenditure for the year. cost convention. The market value of quoted investments Ordinary expenditure is disclosed in a note to the financial statements. Staff pension contributions are credited to the ordinary income Pay expenditure 2 16,553,249 18,437,161 and expenditure account when received and pension Income and expenditure payments are charged to ordinary expenditure when paid. Non-pay expenditure 3 5,286,921 5,167,243 Income and expenditure is recognised when earned or

incurred and is dealt with in the ordinary income and Quoted investments expenditure account or the special fund account of the year to Quoted investments are stated in the balance sheet at cost 21,840,170 23,604,404 which it relates. when purchased, or market value when acquired by way of Ordinary income 4 2,179,609 2,381,465 bequest or gift. The ordinary income and expenditure account reflects the day-to-day running of the hospital. The special fund account The market value of all quoted investments at the balance Net expenditure for year 19,660,561 21,222,939 reflects the results of voluntary activities, investment income sheet date is disclosed in a note to the financial statements. and other receipts and bequests together with their Market value represents the mid price as quoted by a Allocation from HSE towards net expenditure for year 19,892,719 21,208,271 application. The analysis of assets and liabilities in the balance recognised stock exchange. sheet is consistent with this distinction. Fixed assets Surplus/(deficit) for year 232,158 (14,668) Expenses incurred by the hospital, less contributions from Fixed assets for which grants have been received or are patients and other income, are recovered from the Health receivable, or which have been provided out of the special Service Executive by means of an allocation. Accumulated surplus brought forward 106,800 121,468 fund account, are not reflected in the balance sheet. Allocations from the Health Service Executive (HSE) The cost of other fixed assets is charged to the ordinary The total allocation to the hospital towards the net Accumulated surplus carried forward 5 338,958 106,800 income and expenditure account as incurred. expenditure for the year is included in the ordinary income and expenditure account. Any part of the allocation included Capital in the ordinary income and expenditure account but not received at the year-end is included in the balance sheet. Expenditure on premises and equipment 167,405 1,774,299 Grants receivable (167,405) (1,774,299) Allocations in respect of the excess of annual net expenditure over annual allocations are accounted for as and when agreed by the Health Service Executive. - - On behalf of the Board of Management Frank Cunneen Michael Forde

v The Royal Hospital Donnybrook Annual Report & Accounts 2010 Ordinary Income and Expenditure Account Year Ended 31 December 2010

Pensions 2010 2009 The liability in respect of pensions payable is underwritten by Notes € € the Minister for Health and Children and the net cost of Revenue pensions is included in the annual allocation towards net expenditure for the year. Ordinary expenditure Staff pension contributions are credited to the ordinary income Pay expenditure 2 16,553,249 18,437,161 and expenditure account when received and pension payments are charged to ordinary expenditure when paid. Non-pay expenditure 3 5,286,921 5,167,243

Quoted investments Quoted investments are stated in the balance sheet at cost 21,840,170 23,604,404 when purchased, or market value when acquired by way of Ordinary income 4 2,179,609 2,381,465 bequest or gift. The market value of all quoted investments at the balance Net expenditure for year 19,660,561 21,222,939 sheet date is disclosed in a note to the financial statements. Market value represents the mid price as quoted by a Allocation from HSE towards net expenditure for year 19,892,719 21,208,271 recognised stock exchange. Fixed assets Surplus/(deficit) for year 232,158 (14,668) Fixed assets for which grants have been received or are receivable, or which have been provided out of the special Accumulated surplus brought forward 106,800 121,468 fund account, are not reflected in the balance sheet. The cost of other fixed assets is charged to the ordinary Accumulated surplus carried forward 5 338,958 106,800 income and expenditure account as incurred.

Capital Expenditure on premises and equipment 167,405 1,774,299 Grants receivable (167,405) (1,774,299)

- - On behalf of the Board of Management Frank Cunneen Michael Forde

The Royal Hospital Donnybrook Annual Report & Accounts 2010 vi Ordinary Balance Sheet Special Fund Account 31 December 2010 Year Ended 31 December 2010

2010 2009 2010 2009 Notes € € € €

Ordinary assets Income Allocations due - Revenue 6 1,954,694 2,120,159 Investment income 18,135 15,400 - Capital (397,915) 58,015 Rents receivable 1,902 570 Debtors and prepayments 273,860 182,034 Voluntary gifts and donations 31,634 102,105 Bank balances and cash 2,634,472 2,666,632 Investment income - 24,066 Deposit interest 25,558 44,550 4,465,111 5,026,840 Bequests 84,206 174,453

Ordinary liabilities 161,435 361,144 Creditors and accrued expenses (3,079,474) (3,229,120) Bank overdrafts (1,046,679) (1,690,920) Expenditure Other payments 7,061 10,823 (4,126,153) (4,920,040) 338,958 106,800 7,061 10,823

Income less expenditure 154,374 350,321 Represented by: Accumulated surpluses carried forward 5 338,958 106,800 Balance at beginning of year 3,278,642 2,928,321

Balance at end of year 3,433,016 3,278,642

On behalf of the Board of Management On behalf of the Board of Management Frank Cunneen Frank Cunneen Michael Forde Michael Forde

vii The Royal Hospital Donnybrook Annual Report & Accounts 2010 Ordinary Balance Sheet Special Fund Account 31 December 2010 Year Ended 31 December 2010

2010 2009 2010 2009 Notes € € € €

Ordinary assets Income Allocations due - Revenue 6 1,954,694 2,120,159 Investment income 18,135 15,400 - Capital (397,915) 58,015 Rents receivable 1,902 570 Debtors and prepayments 273,860 182,034 Voluntary gifts and donations 31,634 102,105 Bank balances and cash 2,634,472 2,666,632 Investment income - 24,066 Deposit interest 25,558 44,550 4,465,111 5,026,840 Bequests 84,206 174,453

Ordinary liabilities 161,435 361,144 Creditors and accrued expenses (3,079,474) (3,229,120) Bank overdrafts (1,046,679) (1,690,920) Expenditure Other payments 7,061 10,823 (4,126,153) (4,920,040) 338,958 106,800 7,061 10,823

Income less expenditure 154,374 350,321 Represented by: Accumulated surpluses carried forward 5 338,958 106,800 Balance at beginning of year 3,278,642 2,928,321

Balance at end of year 3,433,016 3,278,642

On behalf of the Board of Management Frank Cunneen Michael Forde

The Royal Hospital Donnybrook Annual Report & Accounts 2010 viii Special Fund Balance Sheet Cash Flow Statement 31 December 2010 Year Ended 31 December 2010

2010 2009 Notes 2010 2009 Notes € € € €

Special fund assets Net cash outflow from operating activities 8 (19,984,263) (21,720,672) Quoted investments 7 328,831 331,762 Debtors and prepayments 9,434 9,250 Returns on investments and servicing of finance 9 34,775 62,474 Bank balances and cash 3,094,751 2,937,630 Capital expenditure 9 (164,474) (1,724,299) 3,433,016 3,278,642 Net cash outflow before financing (20,113,962) (23,382,497) Represented by: Special funds 3,433,016 3,278,642 Financing 9 20,883,164 24,244,351

Net cash inflow 769,202 861,854

Increase in cash 10 769,202 861,854

On behalf of the Board of Management On behalf of the Board of Management Frank Cunneen Frank Cunneen Michael Forde Michael Forde

ix The Royal Hospital Donnybrook Annual Report & Accounts 2010 Special Fund Balance Sheet Cash Flow Statement 31 December 2010 Year Ended 31 December 2010

2010 2009 Notes 2010 2009 Notes € € € €

Special fund assets Net cash outflow from operating activities 8 (19,984,263) (21,720,672) Quoted investments 7 328,831 331,762 Debtors and prepayments 9,434 9,250 Returns on investments and servicing of finance 9 34,775 62,474 Bank balances and cash 3,094,751 2,937,630 Capital expenditure 9 (164,474) (1,724,299) 3,433,016 3,278,642 Net cash outflow before financing (20,113,962) (23,382,497) Represented by: Special funds 3,433,016 3,278,642 Financing 9 20,883,164 24,244,351

Net cash inflow 769,202 861,854

Increase in cash 10 769,202 861,854

On behalf of the Board of Management Frank Cunneen Michael Forde

The Royal Hospital Donnybrook Annual Report & Accounts 2010 X Notes of the Financial Statements Notes of the Financial Statements continued

1. Statement of responsibilities of the Board of Management 3. Non-pay expenditure 2010 2009 € € The Board of Management is required to prepare financial statements for each financial year and have them audited. In preparing these financial statements, the Board of Management is required to: € Drugs and medicines 538,958 522,139 • select suitable accounting policies and then apply them consistently; Blood and blood products 5,091 6,174  • make judgements and estimates that are reasonable and prudent; Medical gases 30,684 69,061  • prepare the financial statements on the going concern basis unless it is inappropriate to presume that the hospital Medical and surgical supplies 539,068 681,281 will continue in operation. Medical equipment 18,153 52,241 The Board of Management is responsible for keeping proper books of account which enable it to ensure that the financial Food and catering fees 578,119 630,212 statements are prepared in accordance with accounting standards generally accepted in Ireland and show a true and fair view. Catering equipment 127,800 81,254 The Board of Management is also responsible for safeguarding the assets of the hospital and hence for taking reasonable steps Furniture, crockery and hardware 302,656 203,468 for the prevention and detection of fraud and other irregularities. Heat, light and power 301,724 258,061 Laundry equipment 36,339 9,792 2. Pay expenditure 2010 2009 Cleaning and washing 555,881 614,877 € € Maintenance and renovations 806,925 850,736 € Administration 1,021,120 1,153,266 Bedding and clothing 21,312 19,004 Medical 390,851 383,019 Farm and grounds 224,124 158,272 Nursing and allied 9,884,683 10,956,453 Transport and travelling 7,029 4,262 Paramedical 1,670,672 1,982,474 Transport of patients 137,489 116,137 Catering and house-keeping 1,818,748 1,997,537 Bank interest and charges 10,820 22,112 Maintenance 203,266 210,434 Insurances, audit, legal and other professional costs 122,681 125,074 Pensions payable 1,563,909 1,753,978 Other professional services 227,000 79,534 Office equipment 74,108 47,606 16,553,249 18,437,161 Computer equipment 129,026 106,218 Superannuation administration Office expenses 180,483 171,124 In 2010 pension payments exceeded superannuation deductions by €207,784 (2009: €420,620), as follows: Sundries 311,451 338,604 2010 2009 € € 5,286,921 5,167,243 Pensions payable - once off payments on retirement (422,563) (802,394) 4. Ordinary income 2010 2009 € € - ongoing pension payments (1,141,346) (951,584) Patient maintenance 683,044 875,348 (1,563,909) (1,753,978) Superannuation deductions 1,356,125 1,333,358

Staff restaurant income 88,669 97,216 Superannuation deductions 1,356,125 1,333,358 Sundry income 51,771 75,543 Pension deficit for the year (207,784) (420,620) 2,179,609 2,381,465

xi The Royal Hospital Donnybrook Annual Report & Accounts 2010 Notes of the Financial Statements Notes of the Financial Statements continued

1. Statement of responsibilities of the Board of Management 3. Non-pay expenditure 2010 2009 € € The Board of Management is required to prepare financial statements for each financial year and have them audited. In preparing these financial statements, the Board of Management is required to: € Drugs and medicines 538,958 522,139 • select suitable accounting policies and then apply them consistently; Blood and blood products 5,091 6,174  • make judgements and estimates that are reasonable and prudent; Medical gases 30,684 69,061  • prepare the financial statements on the going concern basis unless it is inappropriate to presume that the hospital Medical and surgical supplies 539,068 681,281 will continue in operation. Medical equipment 18,153 52,241 The Board of Management is responsible for keeping proper books of account which enable it to ensure that the financial Food and catering fees 578,119 630,212 statements are prepared in accordance with accounting standards generally accepted in Ireland and show a true and fair view. Catering equipment 127,800 81,254 The Board of Management is also responsible for safeguarding the assets of the hospital and hence for taking reasonable steps Furniture, crockery and hardware 302,656 203,468 for the prevention and detection of fraud and other irregularities. Heat, light and power 301,724 258,061 Laundry equipment 36,339 9,792 2. Pay expenditure 2010 2009 Cleaning and washing 555,881 614,877 € € Maintenance and renovations 806,925 850,736 € Administration 1,021,120 1,153,266 Bedding and clothing 21,312 19,004 Medical 390,851 383,019 Farm and grounds 224,124 158,272 Nursing and allied 9,884,683 10,956,453 Transport and travelling 7,029 4,262 Paramedical 1,670,672 1,982,474 Transport of patients 137,489 116,137 Catering and house-keeping 1,818,748 1,997,537 Bank interest and charges 10,820 22,112 Maintenance 203,266 210,434 Insurances, audit, legal and other professional costs 122,681 125,074 Pensions payable 1,563,909 1,753,978 Other professional services 227,000 79,534 Office equipment 74,108 47,606 16,553,249 18,437,161 Computer equipment 129,026 106,218 Superannuation administration Office expenses 180,483 171,124 In 2010 pension payments exceeded superannuation deductions by €207,784 (2009: €420,620), as follows: Sundries 311,451 338,604 2010 2009 € € 5,286,921 5,167,243 Pensions payable - once off payments on retirement (422,563) (802,394) 4. Ordinary income 2010 2009 € € - ongoing pension payments (1,141,346) (951,584) Patient maintenance 683,044 875,348 (1,563,909) (1,753,978) Superannuation deductions 1,356,125 1,333,358

Staff restaurant income 88,669 97,216 Superannuation deductions 1,356,125 1,333,358 Sundry income 51,771 75,543 Pension deficit for the year (207,784) (420,620) 2,179,609 2,381,465

The Royal Hospital Donnybrook Annual Report & Accounts 2010 xii Notes of the Financial Statements continued Notes of the Financial Statements continued

5. Accumulated surpluses/(deficits) carried forward 2010 2009 9. Gross cashflows 2010 2009 € € € € € € In respect of prior years: Returns on investment and servicing of finance - 1999 3,566 3,566 Interest received 25,558 44,550 - 2000 112,009 112,009 Interest paid (10,820) (22,112) - 2001 (103,415) (103,415) Investment income 18,135 39,466 - 2002 90,580 90,580 Rents receivable 1,902 570 - 2003 9,193 9,193 34,775 62,474 - 2004 17,391 17,391 Capital expenditure and financial investment - 2005 8,760 8,760 Expenditure on premises and equipment (167,405) (1,724,299) - 2006 (3,250) (3,250) Investment received by way of bequest 2,931 - - 2007 (13,909) (13,909) - 2008 543 543 (164,474) (1,724,299) - 2009 (14,668) (14,668) Financing - 2010 232,158 Maturity of bond 2,931 - Capital grants received 706,209 2,631,265 338,958 106,800 Revenue grants received (Note 11) 20,058,184 21,336,528

Bequests 84,206 174,453 6. Revenue grants due 2010 2009 Voluntary gifts and donations 31,634 102,105 € € In respect of: 20,883,164 24,244,351 - prior years (668) (668) - 2009 - 2,120,827 10. Analysis of the balances of cash as shown in the balance sheet 2010 2009 Change in Year - 2010 1,955,362 - € € € Bank balances and cash 5,729,223 5,604,262 124,961 1,954,694 2,120,159 Bank overdrafts (1,046,679) (1,690,920) 644,241

7. Quoted investments 2010 2009 4,682,544 3,913,342 769,202 € € At cost when purchased, or market value when acquired by way of bequest or gift 328,831 331,762 11. Analysis of changes in financing during the year 2010 2009 € € Market value 290,325 336,971 Revenue allocations At beginning of year 2,120,159 2,248,416 8. Reconciliation of net expenditure to net cash 2010 2009 Allocation for the year 19,892,719 21,208,271 outflow from operating activities € € Cash received (20,058,184) (21,336,528) Net expenditure for year (19,660,561) (21,222,939) Interest included in expenditure 10,820 22,112 At end of year 1,954,694 2,120,159 Payments from special fund account (7,061) (10,823) (Increase)/decrease in debtors and prepayments (91,826) (3,842) (Decrease) in creditors (235,635) (505,180) Net cash outflow from operating activities (19,984,263) (21,720,672)

xiii The Royal Hospital Donnybrook Annual Report & Accounts 2010 Notes of the Financial Statements continued Notes of the Financial Statements continued

5. Accumulated surpluses/(deficits) carried forward 2010 2009 9. Gross cashflows 2010 2009 € € € € € € In respect of prior years: Returns on investment and servicing of finance - 1999 3,566 3,566 Interest received 25,558 44,550 - 2000 112,009 112,009 Interest paid (10,820) (22,112) - 2001 (103,415) (103,415) Investment income 18,135 39,466 - 2002 90,580 90,580 Rents receivable 1,902 570 - 2003 9,193 9,193 34,775 62,474 - 2004 17,391 17,391 Capital expenditure and financial investment - 2005 8,760 8,760 Expenditure on premises and equipment (167,405) (1,724,299) - 2006 (3,250) (3,250) Investment received by way of bequest 2,931 - - 2007 (13,909) (13,909) - 2008 543 543 (164,474) (1,724,299) - 2009 (14,668) (14,668) Financing - 2010 232,158 Maturity of bond 2,931 - Capital grants received 706,209 2,631,265 338,958 106,800 Revenue grants received (Note 11) 20,058,184 21,336,528

Bequests 84,206 174,453 6. Revenue grants due 2010 2009 Voluntary gifts and donations 31,634 102,105 € € In respect of: 20,883,164 24,244,351 - prior years (668) (668) - 2009 - 2,120,827 10. Analysis of the balances of cash as shown in the balance sheet 2010 2009 Change in Year - 2010 1,955,362 - € € € Bank balances and cash 5,729,223 5,604,262 124,961 1,954,694 2,120,159 Bank overdrafts (1,046,679) (1,690,920) 644,241

7. Quoted investments 2010 2009 4,682,544 3,913,342 769,202 € € At cost when purchased, or market value when acquired by way of bequest or gift 328,831 331,762 11. Analysis of changes in financing during the year 2010 2009 € € Market value 290,325 336,971 Revenue allocations At beginning of year 2,120,159 2,248,416 8. Reconciliation of net expenditure to net cash 2010 2009 Allocation for the year 19,892,719 21,208,271 outflow from operating activities € € Cash received (20,058,184) (21,336,528) Net expenditure for year (19,660,561) (21,222,939) Interest included in expenditure 10,820 22,112 At end of year 1,954,694 2,120,159 Payments from special fund account (7,061) (10,823) (Increase)/decrease in debtors and prepayments (91,826) (3,842) (Decrease) in creditors (235,635) (505,180) Net cash outflow from operating activities (19,984,263) (21,720,672)

The Royal Hospital Donnybrook Annual Report & Accounts 2010 xiV Notes of the Financial Statements continued Schools involved in 12. Premises Aos Óg Programme and As stated in the accounting policies on page V, fixed assets for which grants have been received or are receivable, or which have been funded from the special fund account, are not reflected in the hospital’s balance sheet. These fixed assets include the hospital premises, which were acquired in 1792 and have been developed over subsequent years from the special fund account Gaisce – The President’s Award and capital grants.

13. Retirement benefits The financial statements do not contain the disclosure requirements in respect of retirement benefits set out in Financial Coláiste Eoin Reporting Standard 17 ‘Retirement Benefits’. The amount of pensions payable in the year, and the superannuation deductions Belvedere College from staff, are disclosed in the financial statements and their impact on the outturn for the year can therefore be assessed. Gonzaga College S.J. The majority of staff are members of the Voluntary Hospitals Superannuation Scheme, which is an unfunded, pay-as-you-go Dominican College scheme underwritten by the Minister for Health and Children. The Board of Management believes that the funds required in the Blackrock College future to pay current pension liabilities, as they arise into the future, will be provided by the Department of Health and Children Catholic University School under the Voluntary Hospitals Superannuation Scheme and that therefore it is not necessary for the financial statements of the Hospital to include the liability at the balance sheet date in respect of pension entitlements built up to that date by employees of Notre Dame School the Hospital, nor the other disclosure requirements of Financial Reporting Standard 17, because the Board believes that liability Coláiste Íosagáin rests with the Department of Health and Children. Mount Carmel Secondary School Mount Anvile Secondary School 14. Subsequent events Since the year end the Hospital has been advised by the HSE that the 2011 allocation is likely to be reduced compared to 2010 and the Hospital is taking measures to reduce activity to match the reduced funding available.

15. Approval of financial statements The Board of Management approved the financial statements on 28 April 2011.

xV The Royal Hospital Donnybrook Annual Report & Accounts 2010 Notes of the Financial Statements continued Schools involved in 12. Premises Aos Óg Programme and As stated in the accounting policies on page V, fixed assets for which grants have been received or are receivable, or which have been funded from the special fund account, are not reflected in the hospital’s balance sheet. These fixed assets include the hospital premises, which were acquired in 1792 and have been developed over subsequent years from the special fund account Gaisce – The President’s Award and capital grants.

13. Retirement benefits The financial statements do not contain the disclosure requirements in respect of retirement benefits set out in Financial Coláiste Eoin St. Raphaela’s Secondary School Reporting Standard 17 ‘Retirement Benefits’. The amount of pensions payable in the year, and the superannuation deductions Belvedere College St. Dominic’s College from staff, are disclosed in the financial statements and their impact on the outturn for the year can therefore be assessed. Gonzaga College S.J. St. Benildus Secondary School The majority of staff are members of the Voluntary Hospitals Superannuation Scheme, which is an unfunded, pay-as-you-go Dominican College Sandford Park School scheme underwritten by the Minister for Health and Children. The Board of Management believes that the funds required in the Blackrock College Firhouse Community College future to pay current pension liabilities, as they arise into the future, will be provided by the Department of Health and Children Catholic University School Loreto College, St. Stephen’s Green under the Voluntary Hospitals Superannuation Scheme and that therefore it is not necessary for the financial statements of the Hospital to include the liability at the balance sheet date in respect of pension entitlements built up to that date by employees of Notre Dame School Newpark Comprehensive School the Hospital, nor the other disclosure requirements of Financial Reporting Standard 17, because the Board believes that liability Coláiste Íosagáin The High School Dublin rests with the Department of Health and Children. Mount Carmel Secondary School St. Conleth’s College Mount Anvile Secondary School St. Michael’s College 14. Subsequent events Since the year end the Hospital has been advised by the HSE that the 2011 allocation is likely to be reduced compared to 2010 and the Hospital is taking measures to reduce activity to match the reduced funding available.

15. Approval of financial statements The Board of Management approved the financial statements on 28 April 2011.

The Royal Hospital Donnybrook Annual Report & Accounts 2010 47 List of Governors

Mrs. Y. Acheson Mr. Mark Doyle Mr. J. P. Lovegrove Mr. Michael Purcell Mrs. Iris Agnew Mr. H. N. Duffy Mrs. Helen E. Lowe Mr. Lochlann Quinn Mrs. J. Ansell Mr. John Duffy Mrs. Patricia Madigan Mr. John C. Reid Mr. John H. Archer Mrs. Audrey Emerson Mr. D. M. Magee Mr. W. J. Reid Mr. Thomas Bacon Mr. Derek England Mrs. L. Martin Mr. Thomas Rice Mrs. Barbara Baynham Mr. Rodney Evans Mr. Peter Maughan Mr. Graham Richards Mr. Walter Beatty Mrs. Flo Fennell Mrs. Margot McCambridge Ms. Joyce Rigby-Jones Miss Brenda Beaumont Mrs. G. D. Findlater Mrs. Joan McCann Mr. Geoffrey Robinson Rev. Canon R.H. Bertram Mr. John D. Findlater Prof. Geraldine McCarthy Mr. Henry N. Robinson Miss Georgina Black Mr. Vincent Finn Mr. D. C. McCaughey Mr. R. G. H. Roper Mr. Keith Blackmore Miss Dolores Flynn Mr. B. A. McDonald Mrs. Ruth I. Ross Mr. R. Blakeney Mr. Michael Forde Mr. Michael McDowell Mr. John N. Ross Mr. Denis Boothman Mrs. Nancy Fox Mr. Patrick McGilligan Mr. J. M. H. Russell Dr. Brian D. Briscoe Mrs. Heather Fry Mrs. O. E. McGuckin Mrs. Breda Ryan Miss Nancy Bruton Mr. Edmund Fry Mrs. Patricia McHugh Mr. Malachy Ryan Mr. Frank Buckley Mrs. Sylvia Fry Dr. Mary McKiernan Prof. Max Ryan Dr. Helen Burke Mr. W. O. H. Fry Ms. Patricia Mulhall Mr. H. K. Sheppard Mr. Kevin Burke Dr. Graham Fry Mrs. J. Mullen Mrs. Jeremy Sherwell-Cooper Mrs. Joyce Byrne Mr. Colm J. Galligan Mrs. Margaret Murphy Mr. Tom Shields Mrs. Ruth Carnegie Mr. John Gleeson Mrs. T. Murphy Mr. Robin Simpson Mr. Harry Carroll Mr. Peter Gleeson Mr. Gerard Murtagh Mr. Victor Stafford Mr. J. D. Carroll Mr. E. R. A. Glover Mrs. Katherine Nixon Ven. Edgar J. Swann Mr. Peter Kevin Carroll Mr. John Gore-Grimes Miss Gladys Norton Mr. G. J. R. Symes Mrs. Mary L. Carroll Miss D. Graham Mr. J. Nunan Mr. Frank E. Tate Mr. Eric H. Chapman Mr. Alastair Graham Mrs. Catherine O’Connor Mr. Diarmuid Teevan Mr. David P. Clarkin Mr. Randal N. Gray Mr. Michael G. O’Connor Rev. J. Teggin Miss J. Cochrane Dr. Thomas Gregg Ms. Adrienne O’Donnell Mr. Gary R. Tennant Mrs. Jean Cole Miss Ruth Handy Dr. Alan O’Grady Mrs. Sylvia Tennant Mr. Anthony E. Collins Mr. Harry Hannon Mrs. Clare O’Halloran Mrs. Rosemary Thompson Ms. Colette Connolly Dr. Carmencita Hederman Mr. Desmond O’Halloran Mr. John Tierney Mr. L. Cosgrave Mr. William P. Hederman Mrs. Eileen O’Neill Mrs. Anne Tunney Mrs. Vera Cosgrave Mrs. Miriam Hillery Mrs. F. J. O’Reilly Mr. Anthony Twomey Mr. Declan Costello Mrs. J. B. Hodgins Mr. F. J. O’Reilly Mr. Andrew P. Walker Mr. Finbar Costello Mr. Laurence J. Holmes Mrs. Beatrice Ormston Mr. C. Garrett Walker Mrs. Catherine Coveney Mrs. Hassia Jameson Mr. Liam O’Sullivan Mr. Colin C. Walker Mr. Jim Crotty Mrs. Olive Jones Miss Terri O’Sullivan Mr. Raymond M. Walker Mrs. Geraldine Cruess Dr. Donal J. Kelly Mrs. Mary Pairceir Mr. Simon N. Walker Callaghan Mr. Jerry J. Kelly Mr. Seamus Pairceir Mr. Joseph A. Whitten Mr. Frank Cunneen Miss Rosaleen Kennedy Mr. Derek Pearson Ms. Jane Williams Mrs. Deirdre Daly Mr. Charles Kenny Mr. Gordon Poff Mrs. Maeve Woods Mr. James Darlington Mr. John F. Kerins Mrs. Anne Potterton Canon J. L. B. Deane Mrs. Gladys Kingston Mrs. Margaret Power Mrs. Daphne Dillon Mr. Frank Lee Mrs. Penelope Proger

Every effort has been made to ensure that the list of Governors is up to date. However, if you notice an error or omission, please contact the Corporate and Clinical Affairs office at (01) 406 6629

48 The Royal Hospital Donnybrook List of Governors

Mr. Michael Purcell Mr. Lochlann Quinn Mr. John C. Reid Mr. W. J. Reid Mr. Thomas Rice Mr. Graham Richards Ms. Joyce Rigby-Jones Mr. Geoffrey Robinson Mr. Henry N. Robinson Mr. R. G. H. Roper Mrs. Ruth I. Ross Mr. John N. Ross Mr. J. M. H. Russell Mrs. Breda Ryan Mr. Malachy Ryan Prof. Max Ryan Mr. H. K. Sheppard Mrs. Jeremy Sherwell-Cooper Mr. Tom Shields Mr. Robin Simpson Mr. Victor Stafford Ven. Edgar J. Swann Mr. G. J. R. Symes Mr. Frank E. Tate Mr. Diarmuid Teevan Rev. J. Teggin Mr. Gary R. Tennant Mrs. Sylvia Tennant Mrs. Rosemary Thompson Mr. John Tierney Mrs. Anne Tunney Mr. Anthony Twomey Mr. Andrew P. Walker Mr. C. Garrett Walker Mr. Colin C. Walker Mr. Raymond M. Walker Mr. Simon N. Walker Mr. Joseph A. Whitten Ms. Jane Williams Mrs. Maeve Woods

Every effort has been made to ensure that the list of Governors is up to date. However, if you notice an error or omission, please contact the Corporate and Clinical Affairs office at (01) 406 6629

The Royal Hospital Donnybrook The Royal Hospital Donnybrook Dublin 4 Ireland

Telephone +353 (0)1 406 6600 Fax +353 (0)1 406 6605 e-mail [email protected] www.rhd.ie