Community care annual report for the year ended 31st December 1992

Item Type Report

Authors Western Health Board (WHB)

Publisher Western Health Board (WHB)

Download date 04/10/2021 16:55:15

Link to Item http://hdl.handle.net/10147/250291

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Western rd

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COMMUNITY CARE ANNUAL REPORT

For Year Ended 31st December 1992

MISSION STATEMENT OF THE WESTERN HEALTH BOAR

"To promote and achieve good health for its population by the management and deployment of resources through:

• Provision of services

• Research (epidemiological/demographic)

• Provision of information

• Education (people/agencies)

• Professional training

• Development (clinical/management) within the constraints of available resources."

TABLE OF CONTENTS Page No.

Introduction 2 Community Care Programme Staffing 3 Absenteeism Report 5 Income and Expenditure 6 Demographic Trends 7 Registration of Births, Deaths and Marriages 9

Community Protection Services 12 Area Medical Services 13 Environmental Health Services 18 Health Education and Promotion 21 Community Nutrition Project 22 HIV/ AIDS Surveillance 25 Sexually Transmitted Diseases 28 Public Analyst's Laboratory 29

Community Health Services 30 General Medical Services 31 Public Health Nursing Services 34 Dental Services 42 Aural Services 47 Ophthalmic Services 47

Community Welfare Services 49 Home Help Service 50 Home Management Advisory Service 51 Speech Therapy Service 52 Community Physiotherapy Services 54 Occupational Therapy Service 54 Social Work Services 56 Children in Crisis 61 Child and Adolescent Psychiatric Services 62 I Neighbourhood Youth Project 63 Community Psychology Services 64 Services for the Mentally Handicapped 66 Services for the Physically Handicapped 68 Community Welfare Cash Payments 68 Supplementary Welfare Services 69 Voluntary Bodies 78

Other Developments 84 Galway Family Guidance Institute 85 Information Technology 89 Quality Assurance 90 Community Care Standing Committee 90 Health Centre Developments 91 Introduction

The World Health Organisation has defined Primary Health Care as: "Essential Health Care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determination. "

Central to this are a multi~sectoral approach, community involvement and appropriate technology. The Community Care Programme is also concerned with improving the quality of life of the aged, the handicapped and the disadvantaged.

For the purposes of this report, services provided in the Community Care Programme will be dealt with under the following sub~programme heading~

(a) Community Protection Services (b) Community Health Services (c) Community Welfare Services (d) Other Developments

It should be noted that a separate annual report has been prepared in respect of the Public Analyst's Laboratory.

2 Community Care Programme Staffing

Whole Time Equivalents as at 31st December, 1992.

Community Care Areas

Grade ,. Galway Mayo Roscommon Total

Administration 58.00 37.00 18.60 113 .60

Public Health Nurse 82.78 53.18 26.30 162.26

Home Help Service 154.11 129.53 129.25 412.89

Medical 11.55 7.80 5.57 24.92

Para~Medical 11.54 12.61 3.00 27.15

Dental Service 30.77 19.48 6.18 56.43

Community Welfare 24.05 16.19 9.00 49.24

Environmental Health 14.00 7.61 4.00 25.61

Social Work 15 .00 12.00 4.00 31.00

Others & Maintenance 63.00 32.41 17.00 112.41

Totals 464.80 327.81 222.90 1015.51

St. Anne's Children's Centre

Grade W.T.E.

Administration 5.00 Nursing 11.00 Child Care Worker 9.50 Household and Portering 8.00 Medical 6.00 Para~Medical 5.50 Others 1.00 Other Para~Medical _.83

Totals 48. 3

3 Public Analyst's Laboratory

Grade W.T.E.

Administration 2.45 Para-Medical 15.53

Totals 17.98

Aras Attracta, Swinford

Grade W.T.E.

Administration 10.00 Nursing 75.00 Para-Medical 2.51 Housekeeping 16.00 Maintenance 8.62 Others 5.80

Totals 117.93

Registration of Births, Deaths and Marriages

Grade W.T.E.

Headquarters 1.00 Galway 4.00 Mayo 2.50 Roscommon 1.00

Totals 8.50

Community Care Headquarters

Administration 7.00 Para-Medical 3.00 Orthodontic ervice 1.00

Totals 11.00

4 Absenteeism Report

Overall percentage absences for all staff categories on a monthly and annual basis in respect of the years 1991 and 1992 are outlined in the following tables. A significant reduction in the overall average absenteeism rate from 2.89% in 1991 to 2.43% in 1992 was achieved.

Community Care Programme - Absenteeism Report 1991

Yr / Mth Admin. Med / Dent Nursing ParaMed Cater. Maint. Others Totals

91/01 3.16 5.20 4.78 4.42 1.13 4.38 0.50 2.88 91/02 4.59 6.60 5.77 4.12 1.70 5.17 0.99 3.68 91/03 3.92 6.84 4.72 4.82 2.19 2.30 0.92 3.56 91/04 3.75 5.37 4.00 1.72 2.48 0.71 1.76 3.11 91/05 3.58 4.93 4.66 2.47 2.50 3.69 0.14 3.23 91/06 2.84 4.64 3.35 2.88 2.44 0.71 0.51 2.79 91/07 2.71 4.97 2.84 4.39 2.00 7.14 1.92 2.80 91/08 3.33 5.20 2.96 1.75 1.81 7.14 0.64 2.59 91/09 2.71 3.67 4.46 3.30 1.41 7.14 0.07 2.63 91/10 1.63 3.78 4.18 2.10 1.02 3.92 1.28 2.12 91/11 2.40 5.97 4.67 2.04 1.28 6.19 2.28 2.68 91/12 2.70 3.33 4.27 1.03 2.06 2.53 2.49 2.65

Overall Average % Absences of Above 3.11 5.04 4.22 2.92 1.84 4.25 1.12 2.89

Community Care Programme - Absenteeism Report 1992

Yr / Mth Admin. Med / Dent Nursing ParaMed Cater. Maint. Others Totals

92 /01 3.02 4.55 4.97 2.24 1.94 2.91 0.74 3.01 92/02 4.60 4.24 4.82 1.55 2.34 0.78 1.51 3.36 92/03 1.91 2.52 4.33 3.72 1.77 2.18 0.22 2.56 92/04 2.95 3.26 3.67 2.58 2.28 6.58 0.23 2.81 92/05 2.78 0.41 3.57 1.28 1.50 0.64 0.15 2.07 92 / 06 2.59 2.84 3.96 2.45 1.22 2.31 2.40 92 /07 3.23 1.94 3.91 1.34 1.38 1.19 2.35 92/08 3.09 2.16 3.84 0.71 1.46 0.21 0.07 2.24 92/09 3.27 2.70 4.40 1.20 0.80 2.41 4.54 2.49 92/10 2.93 3.29 2.23 1.99 0.88 0.06 1.84 92/11 3.62 3.45 2.23 3.46 0.42 1.67 0.40 2.02 92/12 2.72 3.47 2.27 3.03 0.31 2.22 7.56 2.11

Overall Average % Absences of Above 3.06 2.90 3.65 2.13 1.35 1.62 1.63 2.43

c: Income and Expenditure

Total gross expenditure in the Programme for 1992 amounted to £48.09 m. Total income amounted to £1.39 m leaving the rota I net expenditure at £46.70 m. This was insufficient to maintain the range and quality of services provided in 1991 due to increasing pay costs and the significant increase in the cost of demand - led schemes. However, efforts were focused on providing a high level of service through:-

1. Management of pay costs through the continuing use of the Computerised Whole Time Equivalent System.

2. A significant reduction in the level of absenteeism.

3. Increased emphasis on value for money projects.

Analysis of Non-Capital Income and Expenditure for year ended 31st December, 1992.

1991 Figures in Brackets

Location Gross Expenditure Gross Expenditure Total Gross Total Total Net (Pay) (Non-Pay) Expenditure Income Expenditure

Community 6,542,226 11,733,515 18,275,741 605,037 17,670,704 Care Galway (6,083,987) (11,802,104) (17,886,091) (490,767) (17,395,324)

Community 3,913,773 7,950,303 11,864,076 224,464 11,639,612 Care Mayo (3,638,853 ) (7,348,897) (10,987,750) (285,468) (10,702,281)

Community 1,987,490 3,140,744 5,128,234 259,173 4,869,061 Care Roscommon (1 ,8 16,626 ) (3,016,124) (4,832,750) (196,687) (1,060,449)

St. Anne's 1,018,334 162,915 1,181,249 52,023 1,129,226 Children's Centre (971,293) (146,861) (1 ,118,154) (57,705) (1,060,449)

Aras Attracta 1,516,122 786,204 2,302,326 104,995 2,197,331 Swinford (979,15 ) (660,367) (1,639,525 ) (367,736) (1,271,789)

Public Analysi 379,447 278,644 658,091 102,644 555,447 Laboratory (360,930) (92,969) (453,899) (103,359) (350,540)

Western are - 3, 194,511 3,194,511 - 3,194,511 A iati n (2,941,503 ) (2,941,503 ) (2,941,503) Galwav ounty - 2,699,745 2,699,745 - 2,699,745 ociati n ( ,4 4,710) (2,434,710) (2,434,710) ommunity are I 5,4 5 2,605, 199 2,790,684 43,375 2,747,309 Headquarter (l 2.745) (1,085,784) (1,218,529) ( 127,398) (1,091,131) Totals 15,542, 77 32,551,7 ° 48,094,657 1,391,711 46,702,946 (13,9 3,592) (29,529,319) (43,512,911 ) (1,629,120) (41,883,791)

6 Demographic Trends

A comparison between the 1986 and 1991 censuses of population as they apply to the Western Health Board area is provided herewith. The main population characteristics are outlined and these give a context in which community care services are required:

1. The Western Health Board has the highest proportion of those aged 45 and over in the state.

2. The Board has the second highest dependency ratio of all Health Boards in the country.

3. The Board's area is the least densely populated per square kilometre in the state.

4. The Board has the highest proportion of single and widowed persons in the country.

5. The current rate of marriage in the Board's area is the second highest in the Country and the average age of the bride and groom is the highest in the Country.

6. The Western health Board has the lowest rate of deaths in neo~natal, infant death and peri~natal deaths in the state. BORD SLAINTE AN IARTHAIR WESTERN HEALTH BOARD

CENSUS OF POPULATION, YEARS 1986 AND 1991

AGE GROUPS

GALWAY MAYO ROSCOMMON TOTALS

Age Group 1986 1991 C hange 1986 1991 Change 1986 1991 Change 1986 % 1991 % Change

0-14 51436 49292 2144 - 33269 3 1244 2025 - 15220 141 22 1098 - 99925 28. 69 94658 27.61 5267-

15 - 19 17323 18152 829 + 9615 9324 29 1 - 4584 4283 301 - 3 1522 9.05 3 1759 9.26 237 +

20 - 24 14098 13476 622 - 6601 5705 896 - 3 157 2618 539 - 23856 6.85 21799 6.36 2057 -

25 - 44 44441 46341 1900 + 2711 1 26524 587 - 12604 12327 277 - 84156 24.16 85192 24.84 IOJ 6 +

45 - 54 14955 16885 1930 + 98 18 10388 570 + 4953 4977 24 + 29 726 8.53 32250 9.41 2524 +

55 - 59 7043 6972 71 - 5043 4723 320 - 2744 2489 255 - 14830 4.26 141 84 4.14 646 -

60 - 64 7090 6770 320 - 5273 4803 470 - 2734 2586 166 - 1509 7 4.33 14141 4.12 956 -

65 + 22 166 224 16 250 + 18454 17985 469 - 8596 8492 104 - 492 16 14.13 48893 14.26 323 -

TOTALS 178552 180304 1752 + 115184 11 0696 4488 - 54592 5 1876 27 16 - 348328 l OO 3428 76 100 5452 - Registration of Births, Deaths and Marriages

As Superintendent Registrar, each Health Board has important statutory functions in relation to the registration of births, deaths and marriages and is responsible to the registration system in it's area. The purpose of the Civil Records of Births, Deaths, and Marriages is to keep a long lasting and reliable record of those events. They are kept as separate records i.e. there is no cross reference between a person's birth record and the record of their marriage or death. On May 1st 1992 the Registration Department came into the Community Care Programme for Administrative Purposes. A significant start was made in improving the help available to persons wishing to trace entries relating to earlier family members where they occurred before 1900. The Board came to an arrangement with the South Mayo Family History Society to compile an index to all the births, deaths and marriages in South Mayo for the period 1864 to 1900. The deaths and marriages have been indexed and a printed copy of the index is now available in the Registration Office, at the town hall Castle bar. Work on the index to the births has commenced. During the course of 1993 it is intended to come to an arrangement with other Family History Societies to compile similar indices for other areas.

Events Regis tered from 1972 to 1992 r Galway Mayo Roscommon Totals

Year B 0 M B 0 M B 0 M B 0 M

1972 4020 2094 976 1812 1470 735 366 707 300 6198 4217 2011 1973 4298 1892 1014 1910 1377 670 324 700 271 6532 3969 1955 1974 4349 1977 1012 2031 1421 568 326 724 28 1 6706 4122 1861 1975 4493 1984 1039 1969 1380 622 223 707 333 6685 4071 1994 1976 4521 1948 1001 2100 1313 774 205 731 305 6826 3992 2080 1977 4860 2092 1016 1912 1414 630 163 652 325 6935 4158 1971 1978 4796 1818 1010 1722 1368 594 174 683 333 6692 6935 4158 1979 5102 203 7 1054 2143 1426 892 127 649 346 7372 4122 2292 1980 55 42 2038 1036 2259 1496 870 134 691 342 7935 4225 2248 1981 5516 1841 1033 2075 1357 747 126 636 300 7717 3834 2080 1982 5487 2012 1059 2275 1376 708 130 647 345 7892 4035 2148 1983 5395 1963 1012 2419 1388 648 82 683 298 7896 4034 1958 1984 5609 2013 853 2149 1351 739 36 603 293 7794 3967 1885 1985 4951 2100 928 1969 1343 666 26 663 271 6946 4106 1865 1986 5587 2078 862 1971 1472 652 16 685 287 7574 4235 1801 1987 5225 1900 855 1807 1293 680 19 585 256 7051 3778 1791 1988 4726 1864 927 1726 1392 601 23 589 250 6475 3845 1778 1989 4442 2264 928 1469 1208 626 25 590 264 5936 4062 1 18 1990 4541 1930 853 1545 1341 662 14 601 227 6100 3872 1742 1991 4482 1877 902 1532 1292 574 22 528 229 6036 3697 1705 1992 4508 1982 846 1413 1271 581 22 524 204 5943 3777 1631

9 Hospital Births in the Western Health Board Area

Year Galway Portiuncula Castlebar Roscommon Belmullet Ballina Clifden Annual Total li

11 1982 3133 2469 2212 116 70 3 2 8005 1983 2991 2395 2140 63 60 7 3 7659 1984 2823 2514 2016 23 63 9 0 7448 1985 2635 2455 1915 16 47 0 3 7071 1986 2637 2543 1847 13 53 0 6 7135 1987 2650 2372 1679 4 42 2 1 6750 1988 2405 2219 1583 3 35 1 1 6247 1989 2320 1933 1409 2 28 0 2 5694 1990 2641 2004 1442 3 21 0 1 5932 1991 2426 1920 1435 0 24 0 4 5809 1992 2613 1810 1318 0 14 0 0 5755

NOTE:The figures given above includes births by mothers not residential in this board area.

10 Registration of Births, Deaths and Marriages £OOO's Income Receipts 1982 .. 1992 130

120

110

100

90

80

70

60

50

40

30

20

10 o 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992

Community Protection Services

12 Area Medical Services

Public Health Medicine is concerned with the health of the population or groups of people. It involves (a) The study of health and disease in a defined population. (b) Assessment of the need for preventative and medical services. (c) Allocation of resources to meet these needs.

The work carried out by the Community Care Medical staff exceeds what is normally considered Public Health Medicine. It also involves a large volume of clinical medicine via School Medicals, Development Clinics , assessment of individuals for various allowances and work in the area of infectious diseases:

1. Surveillance and Control of Infectious Diseases: Cases of disease from a prescribed list of infectious diseases are notified to the Director of Community Care who has statutory responsibility for the surveillance and control of communicable diseases. Arrangements for the Notification and Reporting of Infectious Diseases are set out in the Infectious Diseases Regulations, 1981 (S.1. 390 of 1981) and in particular Articles 14 and 15 under which medical practitioners are required to notify cases or suspect cases of infectious diseases seen by them. Infectious Diseases notified to the Department of Health in respect of 1991 and 1992 are aggregated for Galway, Mayo and Roscommon in the attached Table.

2. Child Health- Vaccinations and Immunisation: The measles, mumps, rubella (MMR) vaccinations campaign, introduced nationally in 1988, has been moderately successful. The percentage of eligible children documented as having been immunised falls short of that required to eradicate the disease. The target uptake for measles eradication is 95%. However, uptake rates have been documented at 75%, 82% and 72% over previous years throughout the Board's area. Primary prevention of Infectious Diseases through immunisation is a major aspect of disease control with which the Board is concerned. A high uptake is necessary for the eradication of disease in any target group. The delivery of an effective Immunisation Programme is dependent on the following: 1. The identification of eligible cohorts of children. 2. The provision of up-to-date lists for each General Practitioner so that it is possible to ascertain vaccine uptake for each G.P. 3. Parental education as to the value of vaccination and immunisation programmes.

The lack of data on immunisation returns for Diphteria, Pertussis and Tetanus immunisation from General Practitioners leave the Board with an incomplete picture of the proportion of children immunised. Similarly, the completeness of cases of whooping cough from primary care is also uncertain. In order ro provide accurate epidemiological data, the General Practitioner must devote time and effort and hence be compensated both financially and by epidemiological feedback in the form of an Infectious Diseases Bulletin on a regular basis. It is proposed to introduce the latter during 1993. For Infectious Diseases reporting to be meaningful a standard approach to collection and collation of such data provided by General Practitioners Laboratories and Hospital Clinicians is required. It is proposed to draw up a uniform policy for both primary and secondary prevention of Infectious Disease within the region. The service provided by a good Microbiology Department at diagnostic level aids a sound epidemiological approach to Infectious Diseases Control in the Community. The expert advice of Consultant Microbiologist I Pathologists at University ollege Hospital, Galway, General Hospital, Castlebar and Portiuncula Hospital, Ballinasloe is alway available on occurrence of a disease outbreak (e.g. gastro-intestinal illness, bacterial meningitis and tubercolosis). Improvements in development of surveillance of infectious diseases through the Laborarory system could be further developed. This would allow a more accurate epidemiological profile.

13 Vaccination Uptake Statistics:

Details Galway Mayo Roscommon Total 1991 1992 1991 1992 1991 1992 1991 1992 Diphteria/Tetanus 277 248 23 79 749 455 1049 782 (2 in 1) Diphteria /Tetanus/Pertussis 326 534 16 156 -- 342 690 (3 in 1) B.C.G. Vaccinations 3018 3789 2224 113 431 1315 5673 5217 Rubella Vaccinations 4458 78 189 - 858 - 5505 78 M.M.R. Vaccinations 1498 1917 1871 8949 -- 3369 10866 Poliomyelitis Vaccinations 587 784 27 339 858 533 1472 1656

School Medical Service The School Medical Service is provided by the Board1s Area Medical Officer Staff in conjunction with the Public Health Nursing service and ies objectives are: (a) to offer a comprehensive medical inspection to all children between their 6th and 7th birthdays. (b) to provide selected medical examinations of 9 year olds, where possible. (c) to examine any child referred by the parent, teacher or nurse

School Medical Statistics 1992

Details Galway Mayo Roscommon Total

No. Primary Schools 242 185 96 523

School Population 28,487 19,078 7,980 55545

No. S.M.1.1s 142 22 12 176

No. of children examined 5,615 2,584 1,415 9,614 including screening

14 Tubercolosis Surveillance The control of Tubercolosis in the Community has an important Public Health dimension. It requires a Multi-Disciplinary approach involving Respiratory Physician, Microbiologist, Public Health Doctor and General Practitioner. The quality of morbidity data on Tubercolosis is reasonably good. This is due to the accuracy of case ascertainment and the quality of liaison between the professional staff.

New Cases of Tubercolosis identified in the Western Health Board area from 1988 to 1992 inclusive

Year Galway Mayo Roscommon Total

1988 63 9 11 83

1989 90 22 14 126

1990 81 15 15 111

1991 80 24 24 128

1192 48 16 5 69

Total 362 86 69 517

CRAUG HWELL HEALTH CENTRE

------~----15 ------INFECTIOUS DISEASES 1991 AND 1992

GALWAY MAYO ROSCOMMON TOTAL

1991 1992 1991 1992 1991 1992 1991 1992

Acute Anterior Poliomyelitis ------Acute Encephalitis - 1 -- - - - 1 Acute Viral Meningitis - 3 -- - - - 3 Bacillary Dysentary 419 50 145 16 7 6 571 72 Bacterial Meningitis 6 13 4 7 2 1 12 21 (including Meningococcal Septicaemia) Brucellosis 2 - - 1 -- 2 1 Food Poisoning - 2 -- - - - 2 (bacterial other than Salmonella) Gastro Enteritis (when contracted 75 172 12 26 8 4 95 202 by children under 2 years of age Infectious Mononuclesosis 10 8 - - 1 - 11 8 Influenzal Pneumonia ------Infectious Parotitis (mumps) 1 - - - - - 1 - Legionnaires Disease ------Leptospi rosis - - - 2 - - - 2 Malaria - - - 1 - 2 - 3 Measles 6 1 3 1 - - 9 2 Ornithosis ------Rubella 1 1 - - 1 - 2 1 Salmonellosis 32 14 23 18 10 5 65 37 - INFECTIOUS DISEASES 1991 AND 1992

GALWAY MAYO ROSCOMMON TOTAL

I 1991 1992 1991 1992 1991 1992 1991 199~

Smallpox ------Tetanus ------! Tuberculosis 80 48 24 16 24 5 128 69 Typhoid ------Paratyphoid ------Typhus ------Viral Hepatitis Type A 23 64 7 21 - - 30 85 Viral Hepatitis Type B 1 - - - -- 1 - Viral Hepatitis Unspecified 6 - -- 1 - 7 - Whooping Cough 13 59 2 1 - 7 15 67 Anthrax ------Cholera ------Diptheria ------Plague ------Rabies ------Viral Haemorrhagic Disease ------Yellow Fever ------

-- Environmental Health Services

Growing public awareness of the environment and environmental health issues is a phenomenon which is not confined to Ireland. Throughout the developed and developing world there is a growing emphasis on the relationship between environment and health and the need for regulations and standards to protect and improve the quality of life of the general public. In the simplest terms, Environmental Health Officer's work covers all the measures necessary to deal with factors in the environment which affect human health and as such is concerned with the protection of the public's health in relation to what they eat, where they live and the environment they occupy and carries out this function through it's involvement in housing, planning, Environmental services, food control and health education. The Environmental Health Officer has developed a very special position in relation to the issues of environmental health having a broad base knowledge which enables him/her to take a holistic view of many of the issues confronting him/her and thereby avoiding some of the constraints confronted by the more narrow specialisms in the field.

Environmental Health Officer Service Annual returns for year ended 31/12/92 Health Board Functions Local Authority Functions Description Community Care Area Description Community Care Area Inspections Galway Mayo Roscommon Total Inspections Galway Mayo Roscommon Total Hotels 139 129 47 315 Planning visits 860 309 142 UII Rest./take aways 789 445 142 1376 Housing visits 2976 224 277 3477 Butcher shops 26 1 296 57 61 4 Public Health Bakehouses 130 18 148 Nuisances 109 164 104 377 Food Temporaty Manufacturers 116 131 2 249 Dwellings 65 4 8 77 Food Wholesalers 35 61 36 132 licenses 336 8 2 346 Water & Effluent 1514 574 743 283 1 Foodstalls/vehicles 383 161 145 689 Sanitaty Services 456 18 106 580 licensed Premises 654 576 144 1374 Asahi Samples 411 411 Retail Food Total 63 16 1712 1382 9410 Premises 65 7 675 151 1483 Food Complaints 42 36 33 III Food & Drug samples 796 75 148 101 9 Shellfish 410 102 512 Labelling Regulations 93 69 6 168 Poisons Regulations 59 20 33 11 2 Water Samples (fluoridated) 148 115 112 375 Hospitals/N ursing Homes 57 26 88 N.E.B. Lamb Sampling 40 40 Housing Aid For The Elderly 211 411 277 899 Other Visits 1116 389 238 1743 Totals 6096 3717 1634 11447

The statistics indicate that 45.12% of the total workload of the Board's Environmental Service was carried out on an agency basis for the Board. All work referred by the Local Authorities during 1992 was satisfactorily completed and it is anticipated that E.H.O. involvement in areas such as housing, planning, and Environmental Services will not alter to any great extent during 1993. E.C. directives requiring local authorities to monitor all water supplies in their areas has been undertaken as part of the agency arrangement and it is anticipated that this programme of sampling will be repeated during 1993. With the exception of Community Care Roscommon targets in relation to food sampling were achieved in 1992 and the Board's policy of positive enforcement of Food Hyg iene Regulations against persistent offenders was successful. In spite of verbal and written warnings to offending proprietors it was found necessary to institute proceedings against 11 proprietors in County Galway, 11 proprietors in County Mayo and 1 proprietor in County Roscommon. Fines and costs amounting to £9435 were imposed by the courts in respect of these persistent breaches of the regulations. Work on food sampling in Co. Roscommon was considerably reduced as a result of the E.H.O. involvement in the disposal of fire damaged meat from the U.M.P. plant at Ballaghadereen , Co. Roscommon and the subsequent water monitoring programme. The most significant development in food control for several years was the introduction by the Minister for

lR Health on the 31st of December 19910f the Health (Official Control of Food) Regulations1991. The purpose of these regulations was to implement the terms of E.e. Directive (89/397/EEC) which codified a pan - European approach to food sampling and inspection in order to ensure mutual confidence between member states in each others food control sys tems. There was a consequent substantial increase in the amount of statistics relating to inspection and sampling of foods both for export and domestic consumption required by the Department of Health and the European Commission in Brussels during 1992. The implementation of the controls also led to a significant increase in E.H.O. workloads and an additional three Environmental Health Officers were appointed during the year.

Income:- Income in respect of the various activities carried by the E.H.O. service was generated as follows:-

Community care area Income

Galway £23140 Mayo £14787 Roscommon £ 4415

Total £42342

The main sources from which this revenue accrued were as follows:­ Fees for registration of food premises Administration fees for water sampling Costs of food hygiene courses Fees for licensing food stalls License fees from premises selling poisons

Hospital Hygiene:- During 1992 the Board's Institutions were subjected to comprehensive and regular inspection by Environmental Health Officers. Detailed reports were submitted to Hospital Management outlining all unsatisfactory conditions found and advice was given on any necessary remedial action. The rapid response towards compliance with all the recommendations ensured that the highest standards were maintained.

Housing Aid for the Elderly Scheme:- The Housing Aid for the Elderly Scheme continues to improve the living conditions of man elderly persons throughout the region. Th~ scheme is op~ r ated wit~ the minimum of formality and with the co-~peration of the voluntary and statutory bodies m the Board s area which have been a valuable component of the scheme. The primary aim of works done under the Kheme is to improve th~ living conditions of elderly persons living in unacceptable conditIOns. Normally, h~lp can.be given for works relatmg to the provision of water and sanitary facilities, necessary repairs to make a dwellmg habitable for the Itfetlme of the occupant and cleaning addn re- ecoratmg . wereh ur gently needed. The Environmental Health Service plays a significant role in ensuring the co n tmumg· . success 0 f t h e scheme . Details of the cheme since it's inception in 1982 up to year ended 31st December 1992 are out Ime· d h ereun d er. Community Care Repairs Completed Repairs Completed Waiting list Area 1982 - 1992 During 1992 On 31/12/92 No. cost No.s cost

Galway 746 1,451,331 102 207,641 273 Mayo 610 792,639 68 87,189 242 Roscommon 295 448,076 37 49,558 125 Total 1651 2,692,046 207 344,388 640

19 Health Education and Promotion

Health education and promotion are processes which are aimed at improving the quality of life of the whole population no matter what a person's basic level of health. They are based on the understanding that health is more than an absence of disease. As prevention is a key element in any Community Care Service, the Board's staff are involved both directly and indirectly in health education and promotion on an ongoing basis. The work carried out by the Board's Health Education Department can, for the purposes of this report, be divided into 12 general areas:-

1. Primary Schools 2. Secondary Schools 3. Third Level Schools 4. Schools Inspectorate 5. Voluntary Groups 6. Statutory Bodies 7. Community Groups 8. Media 9. New Materials Published IO.Requests for Information/Videos ete. 11.Activities with Board Staff 12.Training.

The following table illustrates the number and type of courses given by the Board's Health Education Departments during 1992, indicating in each case sample topics covered under each heading.

Description No.of Courses Sample Topics Covered

Primary Schools 11 "A Natural High" competition Teacher's Workshops Secondary Schools 5 Health and Assertiveness Stress Management for Teachers Third Level Colleges 4 Health Promotion Philosophy Schools Inspectorate 3 Transactional Analysis and Health. Child Abuse Voluntary Groups 9 Communication skills Post-Natal Distress Aids Education Statutory Bodies 7 "A Smokefree Workplace" Alcohol Addiction Community Groups 98 Stress Retirement Lifestyle Media 23 Osteoporosis Prostrate/Skin Cancer New Material Published 4 A ids Bookmarks Hygiene chart Requests for Information N/A Health Promotional Material Board Staff 6 Assertiveness and Child Care Workshop Training 8 Health Promotion

21 MANY CHILLED CABI ET DISPLAYS OPERATE AT INCORREcr TEMPERA11JRES. HERE AN ENVIRONMENTAL HEALTH O FFICER IS SEE CHECKlNG THE TEMPERATURE OF SUCH A CABINET AT A LOCAL SUPERMARKET. NlITRITIONAL ADVICE DURlNG "HEALTHY EATING WEEK" 1ST - 7TH NOVEMBER 1992 Community Nutrition Project

The pilot Community Nutrition Project commenced in February 1992. The overall functions of the project were to promote health y eating and life-style guidelines as stated in the "Nutritional Health Promotion - Framework for Action" Policy document, which had as it's overall objective to improve the nutritional status of the Irish population and help reduce the incidence of diet-related diseases. The approach adopted by the Community Nutritionist was:- 1. To provide correct up-to-date nutrition information for existing groups in community as follows :­ (a) Health Professionals (b) Voluntary Groups (c) Community Groups (d) Mentally Handicapped (e) General Public/Media (f) Commerce/Industry (g) Schools/Colleges

2. To make avai lable dietary recomme ndations fo r common bas ic dietary problems such as o verweight, hypercholestorolaemia and maternity onset diabetes, in a form which can be acted upon by the health profess ional and the public.

3. To make available nutrition education literature and audio visual aids.

4. To as e s the need fo r nutrition education resources for use by the Public Health Care Professional and where necessary to develop appropriate resources.

5. To provide training/refamiliarisa tion programmes to update Health Professionals on information regarding current nutritional guidelines.

HEALTHY EATING WEEK:- Healthy eating week was organised by the Community Nutritionalist from 1st November to 7th November 1992 with the theme "Eat Right - Feel Good". The goal for the week was to promote an awareness of the Community utrition Project and the implementation of the Healthy Eating Guidelines bringing about changes in nutrition behaviour and eating patterns. Activities were directed to the consumer in general, and to more specific target groups such as the large supermarkets and food retailers. Health Care workers and Health Education played a vital role as intermediaries.

Health Care Profe sionals

Community Voluntary /Community Groups Consumer

Large Supermarkets/Food Retailers

- An information pack was forwarded to each interested group/organi ation.

- The Galwa)" Chamber ut" ommerce in assoc iated with the Board organised a Food Display Competition .

. The lar!.!e ~lIpcr!lldf k ct~ planned in -~ tore food promotion incorporating the 4 food groups. - The Bo,l[d\ Ilomc t-.1an cH~e l1\ ent Advisors organi 'cd flx)d lemon. tration. and displays.

- The week \\'a, hn.:hlighted thruugh the following: - - 21 c\\'sparer Articles - 17 Pl)s ters - 0 Recipes Certificate: of Participation - -+ Radio Pre entations,

22 30 Community Nutrition Project Inventory of Activities 1992

25

20

V) >= .9 V) V)

10

5

o y Professions Groups Handicap Groups Colleges

'-4--. , ~ .. _- HIV/ AIDS Surveillance

Services for persons who are HIV positive are also provided under the Community Protection Programme. The Board, through it's steering Committee on AIDS has developed a framework for co-ordinating local services and spear-heading prevention. The AIDS co-ordinator keeps abreast of information and developments nationally and internationally as appropriate, and updates the AIDS Steering Committee accordingly. Clinical investigation and management of persons with H.l.Y. infection and AIDS is the responsibility of the physician to whom patients present. Figures are not available in respect of persons with HIV/AIDS in any particular Health Board area. However national and international statistics are available and are outlined in this section. The statistics show the total number of cases of, and deaths from, AIDS reported to the Department of Health up to the 31st December, 1992, together with the test results by category for the HIV antibody during 1991 and 1992. The latest (1991) international figures in respect of AIDS cases show that Ireland ranks 11th amongst the twelve E.C. member states in terms of cases per 100,000 of the population. The cases and deaths reported during 1992 show:- - the number of new cases of AIDS reported in 1992 was 50 compared to 71 in 1991. - the number of deaths from AIDS reported in 1992 was 42 compared to 21 in 1991. - within this overall figure, as has been the case for a number of years, the largest number of cases (27) and deaths (2 1) occurred amongst those whose infection was caused by intravenous drug use.

- the next largest increase in cases (15) and deaths (12) occurred in the Homosexual/Bisexual category.

- in the Heterosexual category a total of 7 cases and 8 deaths occurred during the year.

Features of the epidemiology of AIDS in Ireland show that the greatest percentage (65%) of cases occur in the 20 -30 year age group and 85.5% of cases have occurred in males and 14.5% of females in all age groups.

AIDS CASES AND DEATHS TO 31ST DECEMBER 1992.

CASES OF AIDS 1982 - 1992

82 83 81 85 86 87 88 89 90 91 92 Total Homo/Bisexual 2 0 1 6 21 17 2Z 23 15 109 I V Drug Users 0 0 0 9 10 21 27 31 27 127 Homo/Bisexual IV Drug Users 0 I 1 0 1 1 2 0 0 0 7 Hae mophiliac 0 0 I 0 3 3 3 6 1 3 1 21 Heterosexual 0 0 0 0 0 2 8 11 7 30 Babies born to IV Drug Users 0 0 0 0 2 2 0 8 Babies horn to Hetew:,exual M()ther~ 0 0 0 0 0 0 0 0 0 0 1 Undetermined 0 0 0 I 0 0 0 2 1 1 0 5 Total 2 3 5 6 20 38 51 61 71 50 308

25 DEATHS FROM AIDS 1982 - 1992 82 83 84 85 86 87 88 89 90 91 92 Total Homo/Bisexual 2 0 1 1 1 3 4 7 7 7 12 45 IV Drug Users 0 0 1 0 3 2 11 9 21 49 Homo/Bisexual IV Drug Users 0 0 1 1 0 2 0 1 1 0 0 6 Haemophiliacs 0 0 1 0 3 1 0 1 3 2 1 12 Heterosexual 0 0 0 0 0 0 2 2 2 8 15 Babies born to IV Drug Users 0 0 0 1 0 0 2 1 1 1 0 6 Undetermined 0 0 0 1 0 0 0 2 1 0 0 4 Total 2 1 3 5 4 9 9 15 26 21 42 137

CUMULATIVE TOTAL SAMPLES FOR HIV ANTIBODY

- Test Results by Category Positive Positive Individuals Individuals 1991 1992 CATEGORY Intravenous Drug Abusers:

Male 461 507 Female 150 166 Unknown _ 8 ~ 619 686

Children at risk 78 85

Homosexuals 188 231

Haemophiliacs 112 113

Haemophiliac Contacts 0 0

Hospital Staff/ Occupational Hazard/ Needlestick 0 0

Transfusion 0

Blood Donors 15 17

Organ Donors 0 0

Vi a Request 2

Insurance 0 0

Prisoners 13 13

Hetero/Risk/ Unspecified 129 166

Total 1156 1313

26 - International Comparisons.

Rate per 100,000 population

1. Spain lOAO 2. France 8.20 3. Italy 5.90 4. Denmark 4.10 5. Luxembourg 3.00 6. NetherlanJs 2.80 7. Germany 2.40 8. U.K. 2.3 5 9. Belgium 2.24 10. Portugal 2.22 I l.lreland 1.80 12.Greece 1.50

27 Sexually Transmitted Diseases

Services for persons suffering from sexually transmitted diseases are provided under the Community Protection Programme by the Board's S.T.D clinic. The clinic situated at U.C.H.G provides a comprehensive screening and treatment service free of charge under the Infectious Disease Regulations 1981. It is staffed by a General Practitioner, Public Health Nurse, Senior Area Medical Officer and a Contact Tracer and is supported by the Pathological Laboratories at University College Hospital, Galway.

New Cases of Sexually Transmissible Diseases

Returns for S.T.D. Clinic 1991/1992

Total Number of Sex New Cases Reported M F 1991 1992 91 92 91 92

Ano-Genital Warts 46 55 23 34 23 21 Candidiasis 26 32 12 15 14 17 Chancroid Chlamydia T rachomatis 6 4 5 3 Genital Herpes Simplex 2 2 2 Gonorrhea Gardnerella Vaginalis 14 23 3 14 20 Infectious Hepatitis B Lymphogranuloma Venereum Molluscum Contagiosum 2 2 2 2 Non-Specific Urethritis 14 14 9 11 5 3 Pediculosis Pubis 3 2 Syphilis Trichomoniasis 2 2 ST.D's other than those listed 13 15 7 8 6 7 No. Pathology 77 51 50 34 27 17 HIV Screen Only 3pos. 54 (4 positive) 2 32 22 Total Number of Infections 134 138 66 68 68 70

199 1 1992 Patients attending who had pos itive pathology . 60% 59% The rate for concurrent infection was 16% 21%

28 PUBLIC ANALYSTS LABORATORY

The Public Analyst's Laboratory provides a service in analytical chemistry in the testing of food, drugs, and water supplies for the area covered by the WESTERN, NORTH-WESTERN and MID-WESTERN HEALTH BOARDS. In addition, facilities are provided on a limited scale for industry and the general public.

The Laboratory provides a service on an agency basis, for Nine Local Authorities, to monitor Public Water Supplies, The European Communities (Quality of Water for Human Consumption) Regulations 1988, contain quality standards for drinking water and also set out the frequency and type of testing to be carried out. In addition, bathing waters are checked for compliance with the European Communities (Quality of Bathing Water) Regulations 1988.

For administrative purposes, the Laboratory is divided into Five sections. The total number of samples analysed by each section during 1992 together with a comparison to the 1991 figures are outlined hereunder:-

Section No. Samples 1991 No. samples 1992

EGGQ J05~ 26~9 Water/E££h, lents 5477 6240 Owgs,fTaxicolog¥ 606 514 Ai[ Monitoring 1016 1026 MiscellaneollS 566 524 Total 10,782 11,053

A separate report giving a comprehensive outline of Public Analysts activities 1992 has also been prepared.

29 Community Health Services

30 This sub-programme deals with the general practitioner services, including the supply of drugs and medicines and schemes for subsidising drug purchases, home nursing services, domiciliary maternity services, dental, ophthalmic and aural services.

General Medical Service

General practice is regarded as the single most important element in the Community Health Services sub­ programme. A total of £26,260,195 was paid to participating doctors and pharmacists in respect of fees, allowances and medicines during 1992 under the G.M.S. in the Western Health Board area.

Under the Choice of Doctor Scheme a person eligible to receive free general practitioner services for himse lf and his dependents reg isters with the doctor of his choice, provided the doctor has entered into an agreement with the Health Board and is prepared to accept the patient on to his panel. Except in certain circumstances, the doctor chosen must not live more than seven miles from the patient nor have already a patient list in excess of the maximum number allowed. Where an eligible person does not succeed in obtaining registration, the Health Board arranges to have him entered on a doctors panel.

Drugs, medicines and appliances supplied under the Scheme are provided through retail pharmacies. In most cases, the doctor gives the completed prescription form to the patient, who takes it to any pharmacy having an agreement with the Health Board. In rural areas, where a doctor has a centre of practice three miles or more from the nearest retail pharmacy participating in the Scheme the doctor dispenses for those patients se rved from that centre who opt to have their medicines dispensed by him. The doctor is paid a dispensing fee for each of these patients. The medicines he dispenses are obtained by him through a stock order given to a retail pharmacy participating in the Scheme, located in the doctor's normal area of practice, or, if there are no such premises in that area, located reasonably convenient to the area.

Persons Covered by the Scheme

The number of persons covered by the Scheme in the State as at 31st December, 1992 was 1,263,001 which represented an increase of 25,229 (2.04%) on the number covered as at 31st December, 1991. The number covered in the Western Health Board as at 31st December 1992 was 157,884 which represented an increase of819 (.52%) on the number covered as at31st December, 1991.

Numbers of Docrors and Pharmacies in the Scheme

In 1991 there were 186 J ocrors participating in the scheme throughout the Western Health Board area as compared to 185 by the end of 1992. The number of participating pharmacies decreased to 116 in 1992 from 117 in 1991.

Prescribing Patterns

1990 1991

Numher of Prescriptions 805,687 838,5 18 4.07% 878,301 4.74%

Number ut" PrescriptIon 1terns 1,6 14 .350 1,679,674 4.05% 1,775,537 5.71%

31 Cost per Eligible Patient

Details 1990 1991 %Increase 1992 % Increase

Overall Cost per eligible 137.03 144.90 5.75% 166.59 14.97% patient in W.H.B. area

National Average Cost 135.23 142.95 5.40% 163.54 14.40% per eligible patient

Drug Costs

The average drug cost for the Board in 1992 was £105.50. This compares with a national average of £ 107.34. The following table gives an outline of drug cost by age group in comparison with the national average. It should be noted that in accordance with national trends, the drug costs for the age group 65 years and over is significantly high, in the Western Health Board's case £186.79 which represents 177.64% of the Board's average cost.

Details Age Classification

Under 5 - 15 16 - 44 45 - 64 65 years Health Board 5 years years years years and over average

W.H.B. Cost 37.31 26.76 66.99 142.13 186. 79 105.50

%ofW.H.B. 35.48% 25.45% 63 .71 % 135 .17% 177. 64% average Average 32.43 26.49 70.11 159.47 200.96 107 .34 National Cost % of National 30.21 % 24.67% 65 .31 % 148. 56% 187 .21%

Details of Payments

Payments in respect of General Medical Services in the Western Health Board area were as fo lluws:

Description 1990 1991 % Increase 1992 % Increa e

Doctors 7,42 1,728 7,764,059 4.6 1% 9,629,137 24.02%

Pharmac ists 14 ,607,250 14 ,829,369 1.52% 16,63 1,058 12.15 %

Total 22,028,978 22,593,428 2.56% 26,260,195 16.23%

32 Vocational Training for G eneral Practitioners

Since 1974 the Western Health Board has funded a vocational training scheme for general practitioners, the first in this State, and has now trained over 60 doctors in general practice. Such training, which is mandatory under E.e. leg islation , is fully recognised by the English and Irish Colleges of General Practitioners. Im'estments in the scheme now runs at over £350,000 annually. Within the near future the appointment of a Professor of General Practice at University College G alway, will further enhance the scheme.

B ALLYDANGAN H EALTH C ENTRE

31 Public Health Nursing Service.

The Public Health Nursing service is concerned with providing comprehensive care throughout the lifespan of individuals,families and communities in their own environment. Basic human needs are normally met by the activities of living. One of the skills of public health nursing is to assess the extent of deficiency in the ability for se lf care, the extent to which the individual, the family or community may be able to make good the deficiency and the extent to which intervention is needed. Public Health Nursing is directed at assisting individuals, families and community to determine and achieve their physical, psychological and social potential and to do so within the challenging context of the area changing environment in which they live and work. The Public Health Nurse is accordingly, required to develop and perform functions that relate to the promotion and maintenance of health as well as the prevention of ill health. The work also includes assessment, planning, implementation and evaluation of care during illness and rehabilitation. It encompasses the physical, psychological and social aspect of life as they affect health, illness, disability and dying. I t is essentially a reciprocal and dynamically changing relationship between the client and the Public Health Nurse. Arising from the work of the Quality Assurance Co-ordinating Committee which was established during 1992 and in consultation with the Public Health Nursing representation a P.H.N. Mission Statement was written as follows:­ "The mission of Public Health Nursing in the Western Health Board region is to help individuals , families and gTOuPS to determine and achieve their physical , mental and social potential, and to do so within the challenging context of the elwironment in which they live and work."

The following care groups received a Public Health Nursing Service during 1992:- 1. Ante-Natal Clients 2. Domiciliary Midwifery Cli~nts 3. Post-Natal Mothers 4. Pre-School Children 5. School Children 6. Physically Handicapped Persons 7. Mentally Handicapped Persons 8. Geriatric Clients 9. Psychiatric Patients 10. Others.

34 Details of service provision to the above groups during 1992 are outlined hereunder:-

PUBLIC HEALTH NURSES WORKSHEET -1992

GALWAY MAYO ROSCOMMON TOTAL Total Visits - Clinical 94,162 38,553 24,928 157,643 Routine Visits - Elderly 8,643 24,799 4,874 38,316 At Risk Visits - Elderly 14,176 9,931 8,079 32,186 Neo Natal Visits 4,976 6,121 1,951 13 ,048 Pre-School Visits 14,911 15,753 6,102 36,766 N .A.1. Monitoring 132 153 20 305 Ante Natal Vi sits Primps 41 35 31 107 Ante Natal Visits Others 195 107 86 388 Post Natal Visits 1,209 2,555 720 4,484 Home Confinements NIL(6)* 1 (4)* 2 3 S.M.I.Visits(District Nurse} 17 16 97 130 Social (Multiple}Problem Families 1,610 2,567 1,002 5,179 Infectious Diseases Visits 136 44 20 200 Psychiatric Visits 2,113 885 426 3,424 Handicapped Children Under 16 818 3,189 494 4,501 Handicapped Adults 2,850 1,899 2,126 6,875 Health Education/ P~r~tcra ft Visits 2,608 12,633 3,142 18,383 Visits Requiring Reports 485 1,829 347 2,661 Ineffective Visi ts 4,62 7 4,665 1,284 10,576 Other Visits 7,446 4,590 1,397 13,433 Total Visits - All Categories 161 ,155 130,325 57 ,128 348,608

*Enquiries regarding Home Confinements.

1.ANTE NATAL CLIENTS

The service provided to this category of client continues to be of an advisory nature. There was a small domiciliary service but in the main it was provided through parent craft classes.

Galway Mayo Roscommon Total Domiciliary Ante Natal Visits 1. To Pri magav ida: 41 35 31 107 2. To Others: 195 107 86 388

Number of Parent C raft Courses held: 13 22 3 38

Number of sessions: 62 110 15 210

Number of Persons Attending: 81 238 37 356

During 1992 work continued on the development of a ' tandard regional approach to the provision of Parent Craft Classes. The issue of the expansion of this se rvice to include all are as is currently being addressed and the resource implications are being examined with a view to full implementation by the end of 1993 .

35 2. DOMICILIARY MIDWIFERY CLIENTS

There were no planned domiciliary midwifery cases undertaken by Public Health Nurses during 1992. In Galway Community Care Area 8 Domiciliary deliveries took place during 1992, 2 were emergency deliveries in which the Public Health Nurse was involved. In Mayo Community Care Area there was one emergency delivery with Public Health Nurse involvement. There were two emergency deliveries in Roscommon Community Care Area with Public Health Nurse involvement. There have been a number of enquiries as to the availability of Domiciliary Midwifery Services, the provision of this se rvice is an issue that needs to be addressed as it must be provided by a practising Midwife.

Earl y discharges (i.e. before 4th day post partum) took place and required metabolic screening as follows:

METABO LI C SCREENING IN THE COMMUNITY

Number of Infants Screened % of Births 1990 1991 1992 1990 1991 1992 Galway 715 1355 866 27 .01 % 43% 32.41 % Mayo 165 219 216 10.75% 13.64% 14.53% Roscommon 124 160 138 17.29% 22. 10% 21.36% Total 1004 1734 1220 20.49% 3 1.56% 24.40%

During 1992 the criteria in relation to the time span for provision of this se rvice was agreed with Temple Street Hospital, Dublin. This necessitates the provision of a Week-End Service in some cases. A Reg ional Standard is being written for this service by the Liaison Puhlic Health Nurses in consultation with the Quality Ass urance Co-Ordinating Committee.

3.POST NATAL MOTHERS

An estimated 25.40% of pos t natal mothers in the region were discharged before the 4th day post partum in 1992 - Visitation took place to these mothers as follows:

POST NATAL VISITS

Co.Galway Co.Mayo Co. Roscommon Total 1209 2555 720 4484

Some of the se rvice provided was of an advisory nature while so me was clinical. A standardised approach to the provision of this service has been finalised hy the Public Health Nursing Quality Assurance Group.

A clinical and advisory post natal Public Health Nursing Service will be offered to all mothers commencing in 1993.

A Post Natal Record Card has been designed for this purpose.

As a follow up to the Parent C raft Programme one post natal class wi ll be offered to participants with a view to supporting parents and the prevention of problems.

36 4. PRE SCHOOL C HILDREN

This service continues to constitute a major part of the preventative role of the Public Health Nurse - Visitation in the region took place in 1992 as fo llows:-

C hild Health Visits Co.Galway Co.Mayo Co. Roscommon Total

199 1 1992 1991 1992 1991 1992 1991 1992 Birth Notifications Received: 3165 26 72 1606 1486 424 646 5495 4804

Neo Natal Visits 4100 4976 63 51 6161 1760 195 1 122 11 13088

Pre School V i s i t~ 14373 14911 16337 15753 611 9 6102 36909 36788

Total No. of Visits to fam ilies: 14684 14928 19324 17456 5694 6211 34577 .38595

N.A.I Monitoring Visits: 92 132 37 153 409 20 538 305

T he increase in mothers who wo rk outside the home poses pro blems for the de li ve ry of this service. Many infants and young ch ildren are cared for by childminders and the visit has to be planned when a parent is available. Sometimes they are never available during standard working hours. The delivery of the C hild Health Service without prior appointment can result in parent not being ava il able when the Public Health Nurse calls and leads to the ineffective use of nursing time and travel. Fi\'e key areas have been identified by the Q uality Assurance Co-Ordinating Committee where Regional Standards need to be developed fo r Pre School C hildren as fo llows: (1) On going Developmental Assessment. (2) Cord Care. (3) Screening fo r Congenital Dislocation of Hips. (4) Metabolic Screening. (5) Infant Feeding. Groups of Public Health Nurses are work ing on these issues.

DEVELOPMENT CLINICS HELD IN 1992.

Galway Mayo Roscommon Total

Number of clinics held: 614 335 121 1070

Number offered se rvice: 3562 2478 860 6900

Number cHtended: ,206 2241 720 6167

lI.N.A. ,56 237 141 733

Number Reierred for FurrhL'r In ve'tigation 55 685 107 1350

Thl~ 'c'f\'llT i, ;l "ef\' import

37 5. SCHOOL CHILDREN.

During 1992 Public Health Nurses in Galway Community Care Area continued to provide a school screening service and assisted with the provision of the Immunisation Programme. The screening service was commenced in Mayo Community Care area on the 1st December, 1992 and will be implemented in Roscommon Community Care Area in 1993.

PROVISION OF SCHOOL SERVICE 1992

Co.Galw~ Co.M~o Co. Roscommon Number of Primary Schools 242 185 96

School Population 28,487 19,078 7980

Number of SMI's 142 33 21

Number of children examined including screening 5213 1991 2229

IMMUNISATION IN SCHOOLS

Co. Galway Co.Mayo Co. Roscommon

Rubella - -

Heaf test 11,609 10,788 7,992

B.C.G. 4,149 3,508 1,315

Diph theria{retanus - - 455

Polio - - 533

6. PHYSICALLY HANDICAPPED PERSONS

The Public Health Nursing Service continues to be involved with the provision of care to physically handicapped persons.

The Registrar of Physically Handicapped Persons maintained by the Western Health Board is as follows:

Galway Mayo Roscommon Total

No. of Persons on Physically Handicapped Register on 3 1/12/92 1044 103, 543 2620

38 7. MENTA LLY H ANDIC A PPED PERSONS.

There is collaboration between the Western Health Board and Voluntary Agencies in the provision of service to mentall y handicapped persons. O ngoing liaison between all care givers is essential to ensure the most efficient service possible. Both service providers would benefit from a more structured liaison policy. Details of persons included in the Mentall y Handicapped Register on 31s t December 1992 are as follows: -

Galway Mayo Roscommon Total 1740 1131 507 337 8

8. G ERI ATRIC C LIENT S

At 31/12/92 the Elderl y Case Load (i .e. the number of persons who are currently receiving a se rvice) was: G alway - Routine 4,3 19. At risk 1,481. Mayo- Routine 12,3 15. Atrisk 823. Roscommon - Routine 4,8 74. At risk 8,079.

Visits To Elderl y

G alway Mayo Roscommon Routine 8,643 24,799 4,872

At Risk 14,176 9,93 1 8,079

C linical Incl uding Geri atrics 94,162 38, ') 5.3 24,928

Total 116,98 1 73,2 83 37,88 1

During 1992 an analys is of the fi ndings of the Functional Assessment Screening of the Elderly and Social Assessment Measure which had been piloted in 199 1, was carried out and a fi nal screening model agreed. A large r pilot study is be ing undertaken in ten Public Health Nurses areas in the three counties to estimate the resource implications. The aim is to screen all persons aged 75 years and on :r. using this model within a three month pe ri od. When the res ults of t hi ~ study are ava il able a fi nal decision as to the level of screening that can be provided will be maJ e.

Long Stcw Geri atric .'\~sess m e nt Committee

The LLlnc: 5LlY Geriatric A~sess m e nt Committee continued to function effecti vel y in Co.Mayo and Co.R oscommon. lv1cet i ng~ wen: held o nce weeks. I n Man) ) 14 as~e~, m ents and 71 rc-assessments were carri ed out. In Rn'cnmll1on 16 ~ patienb were a~ses.'c d . The i"ul' uf Ceriatric placement in GalwClY need, to be Cl ddre~se J as a matter of priori ty.

.- \( ) 1/12 /92 : ) P,\[lenh Wl're BLl. lrded U ur In l" liway. Cu.'t - £1,469. ')4 r'.\[IL'nt' WL'rL' B( );\r,k,l Ollt In 1\ 1.IVU. Cu,t - £71, 577 .6 1 h !'.!tll'l1t' WL'rL' F,()ar,kcl ()u t III R()~cn m mnn. Cbt - n.) 6.44

l). 1"51'<. 'HI.-\TR[<. . [~.AT[E. TS.

Thl' r'lIhiIc He,lith l'ur.'In~ .'C[\·lce c,)ntInues to ha\'e some involve ment with psychiatric patients. [Iunn!.! 1991 meeting" will rakc place between SUPf. Public Health Nurses and the Psy c h I' atri, c N ursm' g Sl'[\'ILe \\'irh ,1 \'Iew ro c\,lritiGltinn Llf rolc..; and improving lia ison.

39 10. OTHER C LIENTS

(a)HOSPITAL LIAISONS/DISCHARGE PLANNING.

During 1992 63 73 patients were discharged from hospital into the Community who required follow up care by the Public Health Nurse. Galway - 3 120. Mayo - 2579. Roscommon - 674. This represents an increase of 12.24% regionall y.

(b)PALLIATIVE C ARE SERVIC E.

O ne Public Health Nurse with special training in Palliati ve Care took up duty in Co.Mayo on 1st August 1992. This is a joint funding arrangement 50% Health Board and 50% Irish Cancer Society. The service is operating ve ry well. A second Nurse is to be appointed in 1993. Arrange ments for the employment of a Medical Director are currently in progress for the Mayo and Roscommon areas.

In Co. Roscommo n a similar funding arrangement is in place. O ne Palliative care N urse was appointed on 1st September, 1992. So far the se rvice appears to be satisfactory. A detailed evaluation of the Palliative Care Service from a nursing perspective will be undertaken when the service has been in pl ace for 12 months.

REFERRALS T O THE PALLIATIVE C ARE NURSING - 1992

Referrals I",m Referral, fro m Reterrals Irom T" t, l Nu. N". " I G. P. H"sr iro b O thers Referrals Dea ths May" 19 12 2 33 13 Rl lS( l l m ll h lll 25 25 15

In County Galway the service is provided by the Galway Hospice Team in co-operati on with the Publi c Health Nursing service, liaison between both services is satisfactory.

A pilot study was carried out in 1992 on the use of a Joint Nursing Record Card, work continues on th is project.

(c) TRAVELLERS ST U DY.

During 1992 the Senior Public Health Nurses in the areas produced a report on the health status of trave ll ers in the Western Health Board region.

The recommendations in the report will be implemented during 1993 and a Public Health Nurse Co-Ordi nator has been appointed for a period of six months to undertake this tas k.

(d) CYTO LOGY SERVI CE.

Cytology C linics were carried out regularl y in the three counties. The servi ce was provided hy an ass igned Public Health Nurse (located at the Cytology Department, University College Hospital, Galway). In Galway and Roscommon these cl inics are also serviced by the area Puhlic Health Nurses who carry out a programme of Health Education which includes self-breas t examination. Cytology Screen ing C linics are prov ided by Public Health urses in the Maternity Department, Uni ver ity Coll ege Hospital, Galway every Friday afternoon and once per month in Mervue Health Centre. A simil ar sy. tem is al o in place in Co. Roscommon.

In County Mayo a sess ional urse (R.G.M R.M.) is employed to a~~ i s t in the p ro\' i ~ i () n of thi ~ se rvice.

40 CYTOLOGY CLINIC RETURNS

No. of Clinics Held No. who attended

Galway 208 3718 Mayo 72 1304 Roscommon 23 558 T OTAL 303 5580

41 Dental Services

The statutory role of the Dental Services is to provide dental care for:­ (i) Pre-school and primary school children (ii) Adult medical card holders and their dependents

For descriptive purposes, the Dental Service is divided into:­ (a) Primary care (b) Secondary care (c) Preventative services

(A) Primary Care:- Primary Dental Care is defined as dental care given by the Public Dental Surgeons in Health Board Clinics. In the Western Health Board there is a high dentist: population ratio (1 :5000 approx) and the Principal Dental Surgeons for each Community Care Area have identified priority groups. The service is allocated on a need as distinct from demand basis.

Priority Group Average Population During 1992 Galway Mayo Roscommon Total 1.(a) Pre-school Children 16,222 7,500 3,515 27,237 (b) National School Children 28,487 19,078 7,980 55,545

2.(a) Mentally and Physically 580 2074* 946 3,600 Hand icapped (Ch ild ren and Adults) (b) Geriatric In-patients 669 187 320 1176

3. Adult Medical Card 56,335 32,545 24,590 113,470 Holders

* Includes figures from Western Care Assoc iation

All primary schools in the region are screened every 1 to 1.5 years. Those children in need of elective dental care are called for treatment on appointment and emergency relief pain service is available for all children on demand. The main objectives of the schools service are firstly to complete a Fi sure Sealant Programme for schoolchildren in 2nd class within the school year and secondly to ensure that all 6th class schoolchildren are free from dental cari es on completion of their school year.

Primary Care Statistics for 1992 - Children

Details Galway Mayo Roscommon Total

New Appointments 38,843 20,056 12,995 71,854 Attendances 32,3 12 18,509 11 ,530 62,351 Casuals 2,460 3,758 83 1 7,049 Fissure Sealants 11,290 4,414 2,415 18, 119 Deciduous Teeth Extracted 3,2 15 3,683 686 7,584 Deciduous Teeth Filled 842 836 299 1,977 Permanent Teeth Extracted 1,208 1,839 296 3,343 Permanent Teeth Filled 6,904 4,414 2850 14,1 68 Orthodontic Treatment 551 510 38 1,099 from Health Board Dentists No. Referred to 467 225 465 1,15 7 O rthodontic Waiting List No.Root Canal Treatments 2 13 68 24 305 Dentures 42 34 18 94 Scale and Polish 1,973 1,043 657 3,673

42 There are two elements to Primary Care for Adults:­ (i) Emergency Relief of Pain Treatment (ii) Comprehensive Treatments

Primary Care Statistics 1992 - Adults

Details G alway Mayo Roscommon Total

No. Casual Attendants 306 776 83 11 65 N o. Extractions 624 390 80 1094 N o. Teeth Filled 149 44 18 2 11 N o. Dentures 52 219 - 27 1 N o. Scale and Polishings 57 33 16 106 No. X- rays 40 57 I 108

Ad Hoc Adult Dental Scheme

This scheme which was introduced for the treatment of adult medical cardholders commenced in June 1990. It has two aspects:-

(a) Emergency Treatments:- Pri vate practi t ioners carry out these treatments on behalf of the board at the old soc ial welfa re rate of fees. Patien ts are ei ther self referred or arc referred by the nearest Health Board Dental clinic.

(b) Comprehensive Treatments:- A ll non-emergency dental treatments carried out by participating private prac titioners for eligible patients. No new authorisations were iss ued clfter September 1991, due to lac k of funding. T he rcturns out! ined hercunder represent those cases started in 1991 and completed during 1992.

Details Galway Mayo Ro-;common Total

Emergency Cases Completed 1649 11 Z 63 4 2395

Comprehensive Cases Completed 1094 ZOO 69 1363 Total 27 4, , IZ 703 375 8

R e~ p()nsib ility for the delivery of a Primary Dental Care Service to the mentall y and phys icall y handicapped is ass igned to each Jentist in h is/her L)wn arca. Each dentist also has responsibility fo r the de li very of an emergency relief of pain ,en'icc Dn request to any geriatric, psychiatric or acute general hospital in h is/her area.

(R) Secondary arc Scrvi ce

An Orthodontic Service is pm\'ided hy the Roard in respect of orthodontic defects discovered in children attending primary ~choo k The £!mwth of demand for orthodontic treatment ha" over recent years, been a major problem for the Roard in the ~uppl\' of dcnt;~l sc n 'iccs, Thi~ situation ,hould k alleviated somewhat over the coming years with the arrnintlllcnt hy thc Rn,lrel of a cnmultant orthodontist With cffcct from 1st Novembcr 199Z. It is proposed to provide \)[thndonnc trainl11g tur exi~tll1g Ilc,dth Rumd dcnn't, m'Cr thc ncxt fcw yea rs and this should lead to significant rcductl\)n, 111 the Icn!!rhy \\',\lting li

43 Specialist Orthodontic Care Statistics for 1992

Details Galway Mayo Roscommon Total

No.s Referred 63 40 38 141 No.s Under Care 542 213 52 807 No.s Completed 21 48 35 104 No.s On Orthodontic 1458 367 465 2290 Waiting List At 31/12/92

(c) Preventative Dental Care As the two main dental diseases, dental decay and periodontal disease are preventable, great emphasis is placed by the Board on Preventative Services. Water fluoridation has been enormously successful on combating dental decay and is the cornerstone of the Board's preventative programme. Fluoridation committees have been established in each Community Care area. The regulations made under the Health Fluoridation of Water Supplies Act 1960, stipulate that the concentration of flouride should be maintained between 800 - 1000 microgrammes per litre (or as recommended by the Public Analyst from January 1991, for practical purposes 700 - 1100 microgrammes per litre). Monitoring of the fluoride level is undertaken by the Water Authority (County Council) as agents for the Health Board. There is a regulatory requirement that the fluoride level be tested every day while a full distillation test must be carried out on a monthly basis. The water fluoridation readings in each plant in Counties Galway, Mayo and Roscommon for the 12 months January to December 1992 are outlined in this section of the report. The following table compares these readings with the 1991 results:-

Communitv Care Area % readinps ner cateporv 800 - 1000 m.Q.1. 700 - 1100 m.p.1. 1991 1992 %deviation 1991 1992 Yo deviation Galway 56% 50% -6% 88% 79% -9% Mayo 58% 56% -2% 74% 80% +6% Roscommon 64% 47% -17% 74% 79% +5 %

The comparison reveals a fairly significant reduction in the level of satisfactory results during 1992. The Fluoridation Committees are investigating the reasons for this downturn with a view towards bringing about a substantial increase in the number of satisfactory results during 1993. The fact that an average of 79% of the results were within the 700 - 1100 range would indicate that many of the results were marginally unsatisfactory.

Fluoride Mouthrinse Programme. The Flouride Mouthrinse Programme began in the Galway Community Care Area on a research basis in March 1991 and was subsequently introduced in the Mayo and Roscommon Community Care Areas. The programme is carried out in those areas not in receipt of a fluoridated public water supply. During 1992 a total of 18,392 children, from 2nd class upwards received fluoride mouthrinsing every fortnight throughout the Board's area. A final report of an epidemiological survey to establish baseline data to evaluate the effectiveness of the mouthrinse programme is currently being prepared. A Fluoride Tablet Programme is delivered to mentally and physically handicapped children and some mentally handicapped children through their parents and guardians. Approximately 100 mentally and physically handicapped children are presently receiving this service throughout the Board's area.

Post - Graduate Medical and Dental Board :- The Board employs a part - time course organiser to provide courses for members of the Post - Graduate Medical and Dental Board in conjunction with the Western Regional Dental Committee whose purpose is to promote continuing education for dentists within the region by:- (a) Co-operating with other bodies involved in post-graduate education, viz the Dental Committee of the Board, the Irish Dental Association, other local dental groups or societies and, where appropriate, Dental Hospitals/Universities. (b) The general guidance of the activities of, and in co-operation with, the Course Organiser. (c) The making of recommendations to the Dental Committee of the Board regarding developments necessary within the area.

44 (d) The consideration of the educational needs of dental practice and the relevance of particular activities in meeting those needs. (e) An examination of the steps necessary to ensure that the whole field of primary care is covered over a period of time.

During 1992 six courses were organised on varying topics of dental interest as follows:-

Date Subject Ve nue Attendance

17/1/92 Trauma Castlebar 16 10/4/92 Orthodontics Tuam 20 10/5/92 Dental Materials Ballinasloe 19 16/10/92 Oral Surgery Galway 16 17/10/92 Oral Surgery Demonstration Galway 7 13/11/92 Dental Trauma Galway 19

Fluoridation of Water Supplies - G alway

Location N o. of Samples Range (/lg/l) Mean (/lg/l) 1991 1992 1991 1992 1991 1992 Galway C ity 87 12 260-1020 775-1200 842 980 Athenry 12 12 650-1030 820-1120 906 915 Ballinasloc 13 12 820-940 850-1040 882 1042 C arna 1.3 12 100-1100 820-1290 81 4 857 Clarinbridge 12 12 710-1480 560-1275 898 678 C lifden 12 11 100-1100 120-940 728 914 Kinvara 6 12 740-840 540- 11 60 783 980 Mountbellew 12 12 240-1040 740-1200 763 1303 M id -Galway Regional 12 12 700-110 890-4000 932 936 O ughterard 11 12 640-900 600-830 757 735 Portumna 2 11 830-865 720-1340 848 1005 Spiddal 12 12 700- 1020 380-1060 851 904

Fluoridation of Water Suppli es - Mayo

Location No. of Samples Range (/lg/l ) Mean (/lg/l) 199 1 1992 199 1 1992 1991 1992 Achil l 12 12 100- 1375 560-1 200 803 868 *Rall ina 12 20 700-920 100- 1560 818 862 Ra ll yhaunis 12 12 210-990 220- 1750 611 851 ** Rallinrobe 12 - 660- 11 80 - 900 - Rclmullet 12 12 820- 11 70 870- 1050 938 974 Lough tvh,k Regional \l 10 8 10-940 780- 1060 850 907 Kiltimagh 12 12 700- 1050 41 0- 1080 913 817 Shrllk 12 I 740-11 00 460-980 911 824 , \\'i n(urd 12 12 560-990 180-890 774 737 ort 11 12 80 -1140 Wc'tr 760- 11 60 957 972 **C.btkh.lr - ") .., 790-880 - 843 Cbrclllnrrl' - - - 140-1050 - 695

*R'1 1l1l1.1 - Sll1ce April 1992 sa m~'k s arc being taken from two points, Err in and Li isglennon . ** Ca~ tl char/R.l llinr nbe - ~ incc ·A.rril 1992 both are included in Lough Mask Regional Scheme.

45 Fluoridation of Water Supplies - Roscommon

Location No. of Samples Range (~l) Mean (Ilg/I) 1991 1992 1991 1992 1991 1992 Ballinlough/ Loughglynn 16 12 290-1350 700-830 734 773

Castlerea Regional 17 12 550-110 740-1060 832 904 Castlerea U rban 18 12 255-980 170-390 818 298 Mount Talbot/ Four Roads 16 12 520-1050 930-1200 849 1041 Roscommon T own/ Athleague 18 13 440-1040 330-1050 690 768 North East Regional 19 12 750-930 230-1020 828 713 North Roscommon Regional 17 13 250-920 840-1030 788 915 South Roscommon Regional 15 14 140-960 580-1020 720 778 Cortober 10 - 620-860 - 715 -

46 Aural Services

Screening and testing for hearing loss is undertaken initially by specially trained Public Health Nurses with referral to specialists in the National Rehabilitation Board as required. During 1992 approximately 16,000 children and 1,000 adults were screened. There are approximately 400 deaf persons registered in the Western Health Board region.

Ophthalmic Services

Ophthalmic services are provided by a network of Opticians, Community Ophthalmic Physicians and Consultant Ophthalmologists throughout the Board's area. During 1992, supplementary financial support was also provided to 135 of those registered as blind by payment of the Blind Welfare Allowance. Additionally, the Board provides financial support for the employment of three Social Workers by the National Council for the Blind for care for 560 persons on the register.

Ophthalmic Examinations: No.s Examined

New Cases Recalls

Galway Mayo Rose. Total Galway Mayo Rose. Total 199 1 1992 199 1 1992 199 1 1992 199 1 1992 199 1 1992 199 1 1992 1991 1992 1991 1992

Children 1403 1278 2290 1929 352 248 4045 3455 450 1 5401 11 02 1986 1208 1213 6811 8600

Adults 1364 1179 2439 298 1 621 295 4424 4455 3973 41 05 284 245 790 786 5047 5136

Total 2767 2457 4729 4910 973 543 8469 7910 8474 9506 1386 2231 1998 1999 11858 13736

O phthalmic Appliances Iss ued:

o. persons for whom Number of spectacles spectacles were prescribed supplied

Galway Mayo Rose. Total Galway Mayo Rose. Total 199 1 1991 1992 199 1 199Z 199Z 1991 1992 1991 1992 199 1 1992 199 1 1992 1991 1992

1490 2195 2196 2238 400 364 Child ren 46 6 4797 2196 2195 2296 2238 400 364 4892 4797

9'i2 95b 22 44 2065 510 484 Adult:, 3706 lS05 9552 1190 2244 2065 51 0 484 3706 3739

Total 2942 ll'il 4'i 40 4101 'l IO 848 8192 8302 3148 1385 4540 4303 910 848 8598 8536

47 Ophthalmic Waiting Lists:

Galway Mayo Roscommon Total 1991 1992 1991 1992 1991 1992 1991 1992

Children 3057 3257 3799 2442 72 167 6928 5886

Adults 1276 1765 372 206 190 206 1838 2177

Total 4333 5022 4171 2648 262 373 8766 8043

48

Community Welfare Services

49 HOME HELP SERVICE

The Home Help Service is a discretionary service provided under Section 61 of the Health Act 1970. It is a domiciliary based se rvice designed to provide domestic and personal care in a caring informed and responsible way. It liaises with all community based services and the other Health Board Programmes. The provision of help with activities of daily living is of vital importan ce to the success of a policy to mainta in the elderly and handicapped in dignity and independence in their own home and encourage the support of the local community. The main criterion used in determining the priority which attaches to each application is the degree to which provision of the service would prevent admiss ion to a residential centre or facilitate the earlier discharge of person ' from hospital to the community. The following categories have been identified by the se rvice as priorities:- (a) O lder People: Single or o lder couples li ving alone. (b) Families: Support to families in distress situations. (c) Pre Post-Natal Mothers: Support to mothers in stressful situations. (d) Carers: Support to Carers. (h) Handicapped: Support to physicall y and mentall y handicapped or physically ill. The decision to provide a service is related to the urgency of the circumstances in a particular case rather than the category.

Training:- When a Home Help is appointed preliminary instructions on the broad range of Home Help duties are given by the Home Help Organiser in each area. Further training is arranged on an ongo ing basis. Courses given to Home Helps during 1992 included:- (i) Care of the psychiatric client (ii) Child care (iii) Listening sk ills. Behaviour modification. Alcohol problems (iv) Health Board Structures e.g. reporting relationship, conditions of work, planning work. (v) Family Care. Non-accidental injury. Seminar in child abuse (vi) Care of stroke patients (vii) Lifting techniques (viii) Care of the elderly (ix) Stress management (x) Aids seminar.

Home Help Sen' ice Statistics

Catel;ory G ,dway Mayo Roscommon Total '91 '92 '91 '92 '9 1 '92 '9 1 '92

Fam il ic~ i n Strc~~ Situation, 5 5 I 26 20 19 25 103 96 OlJcr rC Ul'le 61 -1 577 467 465 190 190 1491 1432 rhy,ic dly I Lll1dic ,II'I'CLl 19 60 11 10 7 7 59 77 r~ yc hl.ltnc C ,\,C' 10 19 11 19 7 13 28 51 ~lent . dh · I LIl1 , li c 1rl'cd 10 20 8 15 6 5 24 40

Toml , 751 727 525 529 429 440 1705 1696

50 HOME MANAGEMENT ADVISORY SERVICE

The Home Management Advisory Work Consists of a practical and educational service to families who suffer varying degrees of deprivation due to a range of factors including poverty, over-crowding, inadequacy and illness. Advisory assistance is provided to individual families under the following headings:-

1. Budge ting:- Economical running of the home, shopping wisely, managing household accounts and bills, savings etc.

2. Food and Nutrition:- Planning nutritious and economical meals, storage and preparation and cooking of food.

3. Hygiene:- Advice on personal and household hygiene.

4. Healthy Living:- Sleeping patterns, recreation and play.

5. Housing:- Improvement of housing accommodation and household equipment. Repair, maintenance and decoration of the home.

6. Group Work:- The service is involved in the establishment and support of community groups in conjunction with voluntary and Community Care workers. Classes are provided in home management, cookery, budgeting, nutrition and personal development.

Home Management Advisory Statistics

Case load Category Galway Mayo Roscommon Total '01 '07 '01 '07 -'ill 'S12 -'ill 'S12 Families with young children 38 39 55 56 27 9 120 104

Single Parent Families 26 28 19 15 9 12 54 55

Unemployed - - - 48 22 4 22 52

Illness - - 15 16 8 6 Z3 22

Older People - 3 5 4 - - 5 7

Travelling Families 4 13 3 3 - - 7 16

Group C lasses 15 21 5 9 - 5 20 15

Total Case load 83 104 102 151 66 36 25 1 29 1

51 Speech Therapy Service

The function of the Speech Therapy Service is to assess, diagnose, treat and contribute to the prevention of disorders of communication in children and adults in the community. Assessment, diagnosis and treatment of disorders of communication are often complex and lengthy processes and may require information, intervention and co-operation from other specialists.

The disorders of communication in children and adults can be divided into four main categories: (a) Disorders of Language (b) Disorders of Articulation (c) Disorders of Fluency (d) Disorders of Voice

Disorders of language may be either developmental or aquired. Developmental language disorders are found in association with: (a) Mental Handicap (b) Brain Damage (c) Emotional Disturbance (d) Hearing Impairment (e) Environmental Deprivation (f) Immaturity

Acquired language disorders result from brain damage received following the development of language in the child or adult. Usual causes of these acquired langage disorders are head injuries, infections, degenerative diseases, vascular accidents.

Disorders of articulation and phonology i.e. problemswith speech sound production, are associated with:

(a) Congenital or acquired abnormal ties of the oral structures. (b) Neurological condition affecting the speech musculature (c) Emotional and behaviour problems (d) Development Delay (e) Hearing Impairment

In many cases a phonological disorder is part of a general language disorder.

Disorders of fluency occur where where there is an interruption in the normal flow of speech e.g. stammering and cluttering.

Disorders of voice involves problems with sound production in the larynx and of resonance in nasal and oral cavities. These disorders are found in association with: (a) Vocal strain and abuse due to incorrect voice production (b) Psychological disturbances (c) Endocrine disorders (d) tructural ahnormalities (e) Neurological disorders (f) Tumours of the larynx

The nature of speech therapy is such that the treatment is ongoing, regualr attendance is often necessary on a long dterm basis. The duration and frequency of therapy will vary according to the nature of the presenting d Isor ers.

------52 ------Speech and Language Therapy Returns .. 1992

Details Galway Mayo Roscommon Totals Children Adults Children Adults Children Adults Children Adults 1. Waiting Lists Waiting list for Screening on 1/1/92 210 24 154 - 11 1 375 25 Referred 689 100 372 50 138 23 1199 173 Re-Referred 45 4 27 2 17 1 89 7 Screened 652 95 321 43 130 21 1103 159 Removed from waiting 163 20 58 7 125 - 346 27 List Waiting list for screening 129 13 205 2 24 4 358 19 on 31/12/92

2. Case load Under Treatment 1/1/92 986 75 683 72 175 29 1844 176 New cases taken on 460 80 264 43 187 13 911 136 Discharged 574 86 247 68 42 18 863 172 Under treatment 31/192 872 69 700 47 320 24 1892 140

3. Attendances Assessments 652 95 299 43 130 21 1081 159 Treatments 8253 550 2536 244 2273 158 13062 952 Reviews 603 - 209 42 37 5 849 47 Did not attend 163 20 40 6 12 - 215 26 assessments Did not attend treatments 810 66 410 21 452 7 1672 94 Did not attend reviews 220 35 34 1 13 - 267 36 Total No. Attendances 9508 645 3044 329 2440 184 14992 1158 Total No. 1193 121 484 28 477 7 2154 156 Non-Attendances

An important innovation in the context of Speech and Language Therapy in the Western Health Borad area has been the designation of a Speak Week. During 1992 Speak Week was organised from 19th to 23rd October, 1992 and was aimed at educating the public on how they can be helped by therapy through a series of Poster Displays, Public Talks, Workshops for Parents and Board Staff and a media campaign. Continuous appraisal of service provision is ongoing and in this regard the Speech and Language Departmenl in Community Care Mayo commenced training Public Health Nurses in the use of the Mayo Early Language Screening Test during 1992. Preparations have been made for the production of a video to assist in this training and work commenced on the preparation of an abstract on the test for submiss ion to a conference or Speech and Language Therapy in Copenhagen, Denmark.

SPEECH THERAPY SEMINAR

53 Community Physiotherapy Services

Community Physiotherapy is defined as all physiotherapy measures which are taken outside the hospital based physiotherapy departments. The service is available in all community care areas -throughout the Board. The main priority is the treatment of children and adults with a physical disability and involves domiciliary visits, clinics at health centres, day centres, welfare homes and special schools. The Communiry Phys iotherapist is primarily an educator of patients in prevention of injury and corrector of problems which have already occurred. There is also an involvement in educating Home Helps, Public Health Nurses and other Health Professionals in correct lifting and handling techniques and management of the disabled person at home.

Community Physiotherapy Statistics

Details of Galway Mayo Roscommon Total Visits 1991 1992 1991 1992 1991 1992 1991 1992

Individual 196 22 1 65 - 107 135 368 356

Home Vi its 376 360 20 - 115 123 511 483

Sessions 600 839 20 - 556 372 1,176 1211

Group Attendances 1,935 1,100 45 - 305 210 2,285 1310

Total 3,107 2,520 150 - 1,083 840 4,3 40 3360

Community Occupational Therapy Services

The Community Occupational Therapist is primarily concerned with facilitating the disabled and elderly to achieve maximum Independe~ce and. to become as fully integrated as poss ible within the community. The specific roles of the OccupatIOnal Therapist Within the Community are as follows:-

1. Tlhe as es ment of the individual person's needs and requirements of the family in all aspects of daily IVlng.

2. U ndertaking plann" ed treatment programmed to achieve maX lmum' In. d epend ence 0 f t h e h and IC' apped per'on or t h e famtl ya a umt and prevent disability and dependence.

1. Prcvcnting adml ion to ho pital by identifying problems early and promptly and planning treatment Within thc h me or at a nearby Day Ho pital or out -patlent' d epartment.

4. Training homc arer including Home Helps.

5. E\'alll

7. ~ llntlnllll\!! trcatmcnt programmc~ initiated in h ' I ' d h n ,djll,tll\cnr to dl~ar.ility . 0 plta In or er to effect a return to healt or a

:5rcclal Schoob c,g. therapeutic programme for ind' 'd I h 'ld ff . IVI ua c I ren and d ' h d other sta on ~recitic problems. quipment and architectural needs. a vice to teac ers an

------~--54 ------Community Occupational Therapy Statistics for 1992

Details Galway Mayo Roscommon Total 1991 1992 1991 1992 1991 1992 1991 1992

New Referrals 237 149 65 51 -- 302 200

Home Visits 120 335 184 116 - - 304 451

School Visits (Special Classes) 26 15 10 11 -- 36 26

Treatments at Clinics 475 422 225 163 - - 700 585

Totals 858 921 484 341 -- 1,3 42 1,262

55 Social Work Services.

Social Workers in Community Care are involved in the provision of the following se rvice: 1. Advisory and care work service to families and individuals.

2. Receiving into care of the Board, certain categories of children who cannot remain at home due to prevailing circumstances. This service may be provided at the request of either parents or guardian or by virtue of a court order.

A Child Care Team operates in each Community Care Area. Each multi-disc iplinary team is involved in the early detection of families at risk and in providing intervention, counselling and support se rvices to as ist families to adequately care for their children and as a result to reduce the number of children received into care.

The specialist Child Care Team is also involved in the investigation and validation of reported cases of non-accidental injuries to children e.g Child Abuse (emotional, physical or sexual) . The development of close link and a close working relationship with both the Gardai and teaching profession is being actively pursued by the Board. Social Worker staff are available, on request, to groups of parents, teachers and to schools to provide information on early detection, signs and symptoms of Abuse and to highlight se rvices in place. They are also involved in the following services: (A) Adoption Services: C lann was established on 30th October, 1991 to administer Adoption Services on a regional basis for the Western Health Board area. It provides a comprehensive Adoption Service within the Board's area by formalising Adoption procedure and practice in the area of counselling single parents, assessing prospective adoptive couples, placing infants in adoptive home. and providing comprehensive after- care services to all three. Programmes of information and assessment are also provided for applicants wishing to pursue adoptions under the 199 1 Overseas Adoption Act.

Clann has, in more recent times, received enquiries from married couples who have had unplanned pregnancies and are seeking counselling with a view to considering adoption. Such adoptions can only be processed in accordance with the terms of the 1988 Adoption Act. This development will pose a new aspect for prospective adoptive families who will be required to foster the relevant children for a period of at least 12 months before an application for adoption can be made. In addition, older children in care previously not considered for adoption can now have their eligibility ascertained under the 1988 Act and C lann is actively engaged in seeking permanent adoptive families for such children. Tracing, counselling and Reunion support work have grown considerably during the past year and in this regard Clann is currently developing an effective Tracing Service.

Adoption Statistics for year ended 31 st December, 1992.

(i) Adoption Enquiries

Galway Mayo Roscommon Total Enquiries 176 19 18 213 Applications 59 12 9 80 A pplications prese nrcJ for decision 12 3 4 19

(i i) Adoption Pla ce l1l e nt ~

Galway Mayo Roscommon Total C;i rl , 12 7 2 21 R()y~ 9 9 - 18 Total 21 16 2 )9

------~56 ------(iii) No. of Mothers Counselled

Galway Mayo Roscommon Total Birth Mothers Counselled 54 108 5 167

(iv) Tracing Enquiries

Galway Mayo Roscommon Total

No.Tracing Enquiries 68 29 3 100

(v) Applications under 1991 Overseas Adoption Act.

Details Galway Mayo Roscommon Total

No.of Applications Received 10 11 2 23

No.Couples Assessed 6 2 1 9

Declaration received from Adoption Board Entitling Couples to Travel Overseas to Adopt 1 - - 1

Assessments in Progress 5 4 - 9

(B) Fostering Service: The aim of the Board 's fostering service is the provision of a quality service to foster children which facilitates their growth towards independent adulthood by working in partnership with their parents and fos ter carer. A significant change in how children are cared for can be seen in the growth of foster care as compared to re idential care. 85% of all children incare are now looked after in fo ster care situations and fostering co-ordinators have been appointed in Galway and Mayo Community Care areas. Fos ter Parent Recruitment campaigns are an ongoing activity in the Board's Community Care Departments and appropriate preparation and training courses are organised for persons willing to become foste r parent. Immediate individual assessments are carried out by the Board's Social Wo r ke r~ when participant have completed their courses. Fostering panels were established during 1992 with the foll ow ing aims and objectives: I. To approve or otherwise all prospective fo ter carers. 2. To formulate plans for children awaiting foster care. 3. To discuss the needs of children in foster care and to organise reviews. 4. to address all issues in relation to the fostering service.

In order to ensure a standard approach to Fo ter Care within the region a Practice and Procedurc~ Manual was prepared during 1992 and has been pre ented to all ocial Work ers in the Roard\ area.

57 Foster Care Statistics at 31 st December 1992

Details Galway Mayo Roscommon Total

No.s of children in foster care in Western Health Board Area 71 62 19 152

No.s of children from Western Health Board Area in foster care in other Health Board Areas 6 - 5 11

(c) C hild Sexual Abuse Services: C hild Sexual Abuse referrals are managed by a multi-disciplinary team comprising an Area Medical Officer, Senior Psycholog ist, Senior Public Health Nurse, Senior Social Worker and Child Psychiatrist from the Child Guidance team. The team meets weekl y in each Community Care area with the exception of the Child psychiatrist who is available once monthly to review the cases. T he purpose of the team is to manage C hild Sexual Abuse cases from the initial referral right up to the closure of the ca~e. This incl udes planning for the protection of the child, allocating workers to investigate alleged abuse, planning therapy ancl liaising with outside bodies, espec iall y the Garda Siochana.

58 Child Sexual Abuse Statistics - 1988-1992.

The following table summarises the position in relation to child sexual abuse for each of the years 1988 to 1992 inclusive. 1988 1989 1990 1991 1992 Total

Number of alleged Galway 37 52 80 87 89 345 cases by Community Mayo 14 55 53 49 37 208 Care area Roscommon 5 11 9 15 7 47

TOTAL 56 118 142 151 133 600

Number of cases Galway 13 20 17 16 16 82 where report Mayo 4 29 2 38 20 93 confirmed Roscommon 2 2 7 3 2 16

TOTAL 19 51 26 57 38 191

No.of cases where Galway 1 7 33 22 35 98 report unconfirmed Mayo 0 0 8 0 0 8 and investigations Roscommon 0 2 0 8 3 13 continue

TOTAL 1 9 41 30 38 119

No.of cases where Galway 20 21 33 19 93 report unconfirmed Mayo 7 19 8 6 11 51 and case closed Roscommon 2 7 1 4 2 16

TOTAL 29 47 9 43 32 160

No.of cases of Galway 3 4 30 12 19 68 confirmed non­ Mayo 3 7 40 5 6 61 abuse Roscommon 1 0 1 0 0 2

TOTAL 7 11 71 17 25 131

59 (D) Child Abuse Prevention Programmes: The Child Abuse Prevention Programme was established by Health Professionals working in the area of child welfare and protection. It's primary aim is to prevent child sexual abuse. Parents and teachers are equipped with the knowledge and skills necessary to protect the children in their care. Children are taught safety skills in the normal classroom context and these skills are reinforced through discussion with their parents. This approach helps make children less vulnerable to abuse. The safety skills package, consisting of a video for use in the primary school classroom with two separate curricula for junior and senior cycles, a training course for teachers and an educational component for parents was developed. Evaluation has demonstrated the benefits of the programme. Following discussions with the Departments of H~alth and Education it was agreed to implement this programme throughout all Health Boards in the school year 1992/93. A teacher training team, consisting of a teacher and a social worker was established on 1st September, 1992 and following an intensive three week induction course began implementation of the programme within this area.

Programme Implementation is as follows: (i) Liaison with Community Care staff, child psychiatric services and primary health care teams.

(ii) Meetings with all school managers and all principals.

(iii) Teacher training.

(iv) Co-ordination of liaison meetings between school staff and local Community Care Social Workers.

Parent education is a major focus of the prevention programme in bringing the concept of prevention into a wider community.

Teacher training has been facilitated by the granting of a special training day by the Department of Education. All primary teachers in the Western Health Board area will have received their training by the end of the 1992/93 school year. Teacher training consists: 1. Background information on child Abuse. 2. Disclosures / Suspicions regarding abuse. 2. Reporting and Department of Education guidelines. 4. Structure and role of Community Care / treatment facilities. 5. Teaching Safety ski lls - the STAY SAFE PACK and child Abuse prevent ions.

The Programme also provides a range of skills which assist in coping with bullying, self confidence and personal relationships which are of use in a wise range of social circumstances.

Numbers of School, Teachers and Pupils receiving Programme.

Details Galway Mayo Roscommon Total No. Schools 243 193 91 527 No. Teachers 1093 713 311 2117 28487 No. Pupils 18209 7512 54208

60 Children in Crisis

Services to children in crisis are of particular importance and concern to the Board and the phased implementation of the Child Care Act 1991 has consolidated the Board's role.

(i) Residential Care: Residential child care facilities are provided by Aisling / Loyola Residential Centre, Ballyloughane Road, Renmore, Galway and St. ]oseph's Development Centre, Lower Salthill, Galway who received funding from the Western Health Board in the amount of £346,000 and £317,000 respectively during 1992. Aisling and Loyola are two centres within the one building which cater for boys and girls ranging in age from two to eighteen years of age. Each unit can cater for up to 11 children who avail of educational and training facilities in the local community. The centres are concerned with caring for the educational, vocational, psychological, social and religious needs of the young people and their aim is to create and maintain a stable and stimulating environment that approximates as closely as possible to Christian family life. St. ]oseph's is a specialised open centre which caters for up to sixteen disturbed and disordered young boys who are seriously at risk. The boys, ranging in age from twelve to eighteen years, come from very dysfunctional backgrounds that would include physical violence, sexual abuse, psychiatric illness, physical poverty and from families that lacked any structures or limits. As St. ]oseph's is an open facility, the boys avail of educational, training and work facilities in the local community.

(ii) Homeless ness: The Board, in accordance with it's obligations under Section 5 of the Child Care Act, 1991, is obliged to provide a service for homeless children. In this regard, the Board has made arrangements through Section 65 Grant funding with Galway Diocesan Youth Services, and Castlebar Social Services Council for the provision of the service. The arrangements for the operation of the service will ensure a high quality service to those homeless children for whom the Board has a statutory responsibility. A service for up to 8 homeless boys aged 15 to 18 is provided at Cyrene House Residential Home on a twenty four hour, seven days a week basis. Galway Diocesan Youth Services operate a twenty four hour emergency service to accommodate up to 10 homeless girls aged 15 to 18 years on a short and / or long term basis at Edmund Rice House, Galway. Likewise, the Castlebar Social Services Council operate a Child Care Residential unit for up to 6 children in Aglish Estate, Castle bar, Co. Mayo. Considerable support is provided to the Unit by the Social Work Department at the County Clinic, Castlebar, Co. Mayo and the scheme is funded through Section 65 Grants. The following is the level of grant aid allocated to these agencies during 1992.

Galway Youth Service (Cyrene House) 38016 Galway Diocesan Youth Services (Rice House ) 152,423 Castlebar Social Services Council (Aglish Estate since it's opening on 16/11/92) 4,500

EOMUND RICE HOUSE HOSTEL FOR HOMELESS GIRLS

61 Child and Adolescent Psychiatric Services.

The Child and Adolescent Psychiatric Service is a community-based one which is delivered through multi-disciplinary teams. These teams which are based at St. Anne's Children's Centre, Taylor's hill, Galway and lyradoon Child and Family Guidance Centre, Lower Salthill, Galway provides out-patient services at regular intervals in Castlebar, Ballinasloe, Ballina, Roscommon, Clifden and Tuam as required by caseload. The principal treatment approach at St. Anne's is Milieu Therapy, which requires the hospital and school to function as an integrated whole. This requires careful monitoring and adjustment on an ongoing basis within this overall approach, individual treatments are tailor-made for patients from a range of treatments which include Speech Therapy, Nursing, Individual and Group Psychotherapy, Behaviour Therapy, Remedial Education, Cognitive therapy, Play Therapy and medication. At Lyradoon Family Centre, there is a team which undertakes, on a part-time basis, specialist work of Family Therapy. Increasingly the service is being referred to children with a wide range of problems which they developed in reaction to parents who are in the process of separating or who have recently separated. This is now a widespread community trend, with the result that there is an increasing number of vulnerable children in this position.

Child and Adolescent Psychiatric Service Statistics:-

1991 1992 No. of in-patients treated 59 61 Average duration of stay for in-patients 21 days 19 days No. of out-patients treated 1782 1886

T. A NNE'S CHILDREN'S CENTRE, TAYlOR's HILL

62 Neighbourhood Youth Project

The Neighbourhood Youth Project is a community based child care support service to youth and their families living in the Westside of Galway city. Interventions on the project are made in conjunction with other Health Board agencies primarily the Child Guidance Service and Social Work Department in Community Care Galway. The primary function of the project is to provide a preventative youth/family support service through individual and groups work intervention and indirectly through community support. Ouring 1992 the project ran an average of 8 groups per week which included activity based sessions such as pottery, puppetry, photography, squash, hill-walking, indoor and outdoor soccer and other sports, woodwork, swimming and arts and crafts. Courses on structured social skills and assertiveness were all organised. In September 1992 the project opened an Open House facility to the general youth population in Westside and co-jointly ran a group in the local primary school with the teachers for youngsters who were of concern to both the school and project staff. An independent evaluation of the project commenced in June 1992 with the assistance of the Sociology Dept, U.c.G., with an interim report on the project submitted in December 1992. The final evaluation report will be completed in 1993

N ..Y P Statistics 1992

Details Formal Informal Total

Children on Project as at 1/1/92 30 15 45

Children on Project as at 31/12/92 38 20 58

Referrals (accepted) during 1992 26 - 26

NEIGHBOURHOOD YOlJrH PRO]ECf ACTIVITY WEEK

63 PSYCHOLOGY SERVICES

The brief of the Community Care Psychology Service is to provide a wide variety of appropriate psychological services to children and their families. As well as providing an individual service to clients, psychologists also have a responsibility to provide the psychological component in the Child Guidance Teams. They also have a role in other multi-disciplinary teams, in general health education, and as a consulting resource to other professionals inside and outside the Board. Tables outlining statistics relating to the Psychology services during 1992 are outlined hereunder. Some points should be noted when considering these statistics. The tables reveals some discrepancies which have arisen between the counties. Mayo is fully staffed, Roscommon has no resident psychologist and Galway though hav ing the highest number of psychologists does not have a full complement. As a result an enormous backlog of unseen cases waits in Roscommon. The fi gures show interesting similarities and contrasts. In both Counties the principal reason for referral is "Learning Difficulties". This category accounts for about half of the total referrals in Galway but fewer than one third of the referrals in Mayo. Behaviour and Emotional problems account for a higher percentage of referrals in Mayo than in Galway. The differing fig ures for Child Sexual Abuse referral are explai ned by the fact that this work is undertaken to a much greater extent by psychologists in Mayo than in Galway, where it is primarily the concern of Social Workers.

R,easons for Referral:- Reason Galway Mayo Total % for % for %of Galway Mavo Total Learning 236 78 314 48.86 27.66 41 .05 Behaviour 105 48 153 21.74 17.02 .20 Emotional - 38 38 - 13A8 4.97 Child Sexual Abuse 7 37 44 1.45 13.12 5.75 Language 25 7 32 5.18 2A8 4.18 Query Mental Handicap 7 12 19 1.45 4.26 2.48 Parenting 3 6 9 .62 2.13 1.18 Developmental Delay 26 12 38 5.38 4.26 4.97 Management 11 2 13 2.28 .7 1 1.70 Enuresis/ Encopaesis 4 9 13 .83 3. 19 1.70 Physical Handicap 18 17 35 3.73 6.0, 4.58 Social Immaturity - 2 2 - .71 .26 Bereavement 3 1 4 .62 .3 5 .52 Re: Terminal Illness - 4 4 - 1.42 .52 Sensory Handicap 1 1 2 .21 .35 .26 Family Law/ Marital Problems 2 3 5 Al 1.06 .65 O ther 15 5 40 7.25 1.77 5.2.3

Total 483 282 765 100 100 100

------64 Sources of Referral:- I~ ource ualway Mayo lotal 'rotor '?'o tor '?'oot Galway Mayo Total IArea Medical Officer 4 45 49 .83 15.96 6.41 CS.A Core Group - 35 35 - 12.41 4.58 Speech Therapy 61 33 94 12.63 11.70 12.29 Parents 105 20 125 21.74 7.09 16.34 Social Worker 14 22 36 2.90 7.80 4.71 Public Health Nurse 49 12 61 10.14 4.26 7.97 General Practitioner 31 22 53 6.42 7.80 6.93 Teacher 99 20 119 20.50 709 15 .56 Remedial Teacher - 11 11 - 3.90 1.44 Child Guidance Psychiatry 55 6 61 8.70 6.74 7.97 Self 4 5 9 .83 1.77 1.18 Solicitor 2 1 3 .41 .35 .39 Pediatrician 42 19 61 8.70 6.74 7.97 Mental Handicap Services 7 4 11 1.45 1.42 1.44 Physical Handicap Team - 14 14 - 4.96 1.83 Case Conference - 9 9 - 3.19 l.l8 CR.C - 1 1 - .35 .13 Other 10 3 13 2.07 1.06 1.70 lotals i S3 Z'dZ {b'J TOO lUU lUU

65 SERVICES FOR THE MENTALLY HANDICAPPED

There are some 3378 persons on the Mental Handicap Register for the Western Health Board area as of 31st December 1992. The register, which is maintained by the Brothers of Charity on a computerised system, is the first of it's kind in Ireland. The Board has developed, in partnership with the Brothers of Charity, Western Care Association, Galway County Association and St.Hilda's Association, an effective and efficient network of services for the Mentally Handicapped. The provision of these services in compliance with the Board's statutory duty is welded together at the Regional Co-Ordinating Committee on Mental Handicap which seeks by consensus, to address the unmet needs on a planned and prioritised basis.

Aras Attracta:- Aras Attracta, Swinford currently provides respite care and bungalow accommodation for 132 mentally handicapped persons requiring a high degree of care together with 26 respite places with associated workshops and vocational training units.

(a) Age and Degree of Handicap of Residents Aras Attracta on 31st December 1992.

Degree of Handicap

Age Mild Moderate Severe Profound Total Male Female M F M F M F M F

15-19 1 2 3 20-34 1 2 6 4 10 7 1 18 13 35-54 1 4 23 15 20 18 44 37 55-64 2 4 4 4 6 8 65+ 2 1 1 2

Total 2 6 32 25 37 29 1 72 60

(b) Admissions

Types of Admiss ion 1991 1992 Non-Temporary 28 58

Temporary Admissions(e.g. Holiday periods, on trial or crisis relief} 40 54

Transferred from Psychiatric Hospitals 68 112

(c) Age and Degree of Handicap of Persons in Day Care Centres on 31st December 1992

Degree of Handicap

Age Mild Moderate Severe Profound Total M F M F M F M F M F 20-34 2 I 2 3 2 35-54 I 2 3 55 -64 I 1 65+

Totals 3 3 I 2 6 3

66 RECREATION CENTRE The Recreation Centre has been constructed to international standards.

Clients are assessed in all aspects of physical ability and an individualised physical educa­ tion plan pref:)ared.

The swimming 'facilities are used by clients as an expansion of skills, learned in other areas, combined with the fun that extends from group interaction, with water con­ fidence and discipline learned w ithin a friendly atmosphere. Services for the Physically Handicapped

The development of the Physiotherapy and Occupational Therapy services(already outlined in this report) together with the home care attendant scheme, have focus sed specifically on the needs of this care group. Voluntary Organisations such as the Irish Wheelchair Association, Multiple Sclerosis, Ireland and Cerebral Palsy, Ireland supported by the Board, are to the forefront in providing services identified by clients as required. Residential care for the physically handicapped is provided by the Cheshire Home Foundation in Bohola, Co.Mayo and grant aid amounting to £24,000 was provided by the Board during 1992.

No. on Physically Handicapped Persons Register

COMMUNITY WELFARE SERVICE

The Community Welfare Service is responsible for the administration and investigation of all the Western Health Board income/maintenance schemes, together with the National Clothing Scheme and the Fuel Scheme insofar as it extends to recipients of Western Health ooard allowances. Under the terms of the Social Welfare (Consolidation) Act 1981 the Community Welfare Service may provide financial assistance to anybody in an emergency situation, whether they be employed or unemployed. Community Welfare Officers also undertake assessment of eligibility for medical cards and for entitlement to residential care. The urbanisation of the population has required re-organisation of districts on an ongoing bas is to ensure the best quality service for the public. July 1992 saw a very significant change for the better for both the client and the Community Welfare Officer with the move from the cash payment system to a cheque payment system. The transition was effected with little disruption and the new system has been working to good effect since implementation.

Details of Income/Maintenance Allowances for Year ended 31st December 1992 I Allowances No. of Beneficiaries Annual Cost Galwav Mavo Roscommon Total of Allowances 1991 1992 1991 1992 199 1 1992 1991 1992 199 1 1992 Disahled Person's Maintenance Allowance 1711 1888 1489 1518 541 558 3741 3964 10,767,525 11 ,677,995 Disabled Person's Rehabilitation Allowance 129 137 94 103 52 56 275 296 578,438 795,044 In fectious Diseases Maintenance Allowances 3 3 3 I 6 4 21,593 13,861 Mohility Allowances 72 79 95 103 13 13 180 195 68,607 79,826 Domiciliary Care Allowances 395 405 224 225 81 88 697 718 739,824 754,524 Capitation Fees 150 159 90 96 54 58 294 313 194,242 289,276 Maternity Cash Grants 161 233 104 68 14 20 279 32 1 2,296 3,389 Clothing & Foorwear Schemes 8747 10,127 6938 8481 2252 2838 17 ,937 21,446 565,377 868,405 Supplementary Welfare Allowance 1960 10.459 499 3634 274 2253 2733 16,346 6,931,000 8,018,281 National Fuel Scheme 474 563 17l 1208 141730

------68 The Supplementary Welfare Allowance Act 1975 gives every person in the state, whose income is insufficient to meet his needs and the needs of his dependents, a statutory right to an allowance. The 1975 Act has been embodied in the Social Welfare Consolidation Act 1981. The principle of the scheme is to ensure that every person has an income not less than the rate of employment assistance and to act as a safety net for persons awaiting determination of entitlement to Social Welfare Schemes.

Breakdown or Expenditure by Reference to General Classification of Payments

Classification Galway Mayo Roscommon Total Basic Supplementary 2449845 1598000 642320 4690165 Welfare Allowance

Rent Supplement 1224922 336000 83159 1644081

Mortgage Supplement 881944 182000 33264 1097208

Diet Supplement 19599 9000 3326 31925

Other Supplements 63696 30000 10812 104508

Exceptional Needs Payments 259684 132000 58710 450394

Totals 4899690 2287000 831590 8018281

SOCIAL SERVI CES C ENTRE, T UAM

69 Disabled Persons Maintenance Allo

3950

3900

3850

3800

3750

3700

3650

3600

3550

3500 1989 1990 1991 1992 1. No. of Recipients Disabled Persons Rehabilitation Maintenance Allowance 1989 .. 1992 300

250

200

150

100

50 o 1989 No. of Recipients Disabled Persons Maintenance Allowance 1989 .. 1992 12.5

12.0

11.5

11 .0

10.5

10.0

9.5

9.0

8.5

8.0

£M Expenditure Disabled Persons Rehabilitation Maintenance Allowance 1989 .. 1992 900

800

700

600

500

400

300

200

100 o 1989 1990 £OOO's Expenditure Refund of Drugs Scheme 1989 .. 1992 20

18

16

14

12

10

8

6

4

2 o 1991 1992 NW?;; No. of Refunds of Drugs Scheme Recipients . ': No. of Dru g Cost Subsidisation Scheme Recipients Refund of Drugs Scheme £OOO's 1989 .. 1992

1400 --r------~

1300 --

1200 --

1100 --

1000 --

900 --

800

700

600

500 1989 1rrwm Expenditure on Refund of Drugs Scheme .:~:' Expenditure on Drug Cost Subsidisation Scheme Long Tenn· Illness Scheme 1989 .. 1992 3600 -.------,

3400 -

3200

3000

2800

2600

2400 -

2200 -

2000 _ L __ 1989 1990 1991 1992 Long Tenn Illness Scheme 1989 .. 1992 1000

980

960

940

920

900

880

860

840

820

800 1989 1990 ~:mEjl £OOO's Expenditure

Voluntary Bodies

The Western Heath Board networks with a wide range and a large number of Voluntary Organisations whose activities embrace a great diversity of service provision. The Board has always recognised the value of the contribution that the Voluntary Organisations make towards the provision of services and it continually strives to devise mechanisms to enable a meaningful partnership relationship which clarifies the respective roles and obligations of each party to develop. To this end meetings between the Programme Manager, Community Care and the Voluntary Social Services Regional Group are arranged on a quarterly basis each year.

1. Section 65 Grants: ~ Section 65 of the 1953 Health Act empowers Health Boards to support organisations providing a service "similar or ancillary" to a Health Board service. During 1992, a total of £1,110,148 was paid by the Western Health Board to 172 Voluntary Organisations throughout the Board's area. This does not include payments made to Voluntary Organisations providing services for the Mentally Handicapped i.e. Galway County Association for Mentally Handicapped Children and Western Care Association or to Agencies providing residential care for children in care i.e. Aisling / Loyola and St. Joseph's. Details of payments to these organisations are outlined in the Income and Expenditure and Children in Crisis sections of this report. Grant Paid Galway Section 65 Payments in 1992 £ Ahascragh Social Service Council 1,400 Athenry and District Social Service Council 16,000 Ballinakill Older People's Group 750 Ballinasloe Social Service Council 67,000 Ballygarrroghergar & Newbridge Social Service Council 4,000 Caltra Social Service Council 1,000 Carna Coiste Cabhrach Ord Mhalta 2, 500 Clonberne Social Service Council 400 Dunmore Social Service Council 1,000 Eyrecourt/Killimor Day Care Centre 17,000 Galway Social Service Council 275,000 Glenamaddy Day Care Centre 35,000 Glenamaddy Social Service Council 4,000 Gort and South Galway Social ervice Council 15,000 Kilkerrin Social Service Council 100 Loughrea and District 6,000 Menlough Social Service Committee 500 Mountbellew Social Service Council 6 Moylough Social Service Council 1,100 North Connemara Day Care Centre ( lonbur) 13,000 Portumna Social ervice C unci I 3,000 Tuam ocial ervice Council I ,000 Williamsrown ocial ervice 9 Round tone ommunity unci l 1,500 Aha cragh Playgr up 10 ano Nag le Pre- chool, Athenry 3,000 Ballinfoyle C mmunity Playgroup 1,44 Ballinfoyle Play cheme 6 Ballybane Playgroup 1,44 Ballybane Community Hou e 3,000 Bohermore Playgroup 1,17

7 Grant Paid £ Bohermore Playscheme 700 Caltra Playgroup 630 Cleggan/Claddaghduff Playgroup 1,170 Clifden Playgroup 1,440 Clonbur Playgroup 360 Galway Travellers Playscheme 700 Glenamaddy Playgroup 720 Glenamaddy Mothers & Toddlers 360 Holy Trinity, Mervue 4,000 I.S.P.CC Rainbow Pre-School 4,000 Kinvarra Playgroup 1,350 Lettermore Playgroup Toureen 900 St. Clare's Playgroup, Loughrea 3,000 Mervue Community Playgroup 1,710 Moylough Community Playgroup 450 Mountbellew Community Playgroup 990 N aoinra lnishmore 900 Naoinra Lettermullen 630 Naoinra an Chnoic, Tir an Fhia, Lettermullen 1,440 Naoinra Mhic Dara, Carraroe 1,000 Naoinra Glinsk 900 Presentation Convent, Galway 3,000 Scoil an Linbh losa 4,000 Scoil Bhride Shantalla - Growing Child Project 2,340 Scoil Bhride, Shantalla 8,000 Shantalla/Westside Playscheme 600 Rahoon Park Playgroup 2,160 Renvyle Playgroup 1,620 Roundstone Playgroup 360 Skehana/Menlough Playgroup 720 St. Bridget's Special School 10,500 St. Theresa's Playgroup Vicarchorelan, Tuam 2,500 Tuam Social Service Centre Playgroup 2,500 Mervue/Ballybane Playscheme 600 Brainwave 2,000 CM.A.C 10,500 Contact 600 C yrene House 11 ,000 East G alway Foster Care Association 600 Federation of Services for Unmarried Parents and their Children 2,000 Forum (Primary Health Care) 5,000 Cerebral Palsy - Galway Branch 20,000 Galway Family G uidance Institute 10,000 Galway unshine Holiday Scheme 2,500 Irish Heart Foundati on 2,000 Irish Foster Care Association - Galway Branch 600 Irish Wheelchair Association 25,000 Le C heile 3,000 Little Sisters of the Assumption 8,000 O rder of Malta C orps 5,000

79 Grant Paid £ Multiple Sclero i Society 15,000 National Council for the Blind 14,100 Retirement Planning Council of Ireland 1,000 Simon Community, Galway 23,000 Society of t. Vincent de Paul 8,000 Tuam Travellers Support Group 1,000 Samaritans - Capital 5,000 - Revenue 3,000

UB-TOTAL 738,320

Ro common

St. Mary's Convent N .S., Roscommon 2,841 Board of Management, N.S., Boyle 2,062 St. Hilda's School, Athlone 74,090 12,500 St. Michael's School 6,701 St. Anne's School, Castle rea 13,000 Strokestown Social Service Council 11,000 National Council for the Blind 14,000 St. Asicus Social Service Council 3,500 Roscommon Resource Centre 1,480 Strokes town Community Playgroup 2,616 Castlerea Community Playgroup 794 Ballaghaderreen Community Playgroup 423 Cam Community Playgroup 600 Child's Play 100 Ballintubber Ladies Club 2,000 Roscommon Social Service Council 500 Ballinlough Care of the Aged 1,388 Boyle Community Playgroup 6,000 Athlone C.S.c. 1,000 Brideswell Community Preschool 1,000 Lisnamult Community Centre 8,000 Roscommon Community Playschool 2,000 Office of Family Ministry, Boyle 2,000 Castlerea Social Services Council 100 Kilmurray Ladies Committee 200 Ballinaheglish Care of the Aged 500 Roscommon Regional Youth Services 600 Cloonfad Social Service Council 5,000 Irish Wheelchair Association 200 Roscommon Active Age Group 1,500 I.S.P.c.c. 100 Foster Parents Association 500 Drum Community Care 178,295 SUB-TOTAL

80 Mayo Grant Paid £ Social Services Council, Kiltimagh 3,100 Mary Aikenhead Social Services Council, Foxford 1,800 Social Services Council, Castle bar 14,100 CM.A.C Centre, Castle bar 1,800 Social Services Council, Ballina 4,500 St. Colman's Residential Unit & Keel Day Care 39,000 Irish Childbirth Trust 300 Social Services Centre, Claremorris 340 Irish Association for Spina Bifida 1,173 Knockmore Communiry Care 200 Tourmakeady Day Care Centre 1,000 Irish Foster Parents Association (Mayo Branch) 200 Ballina Invalid Residential Care Group (Emmanuel House) 42,160 National Council for the Blind 10.800 Mulranny Day Care Centre 650 Q'Dwyer Cheshire Home 20,000 Social Services Council, Crossmolina 5,000 Social Services Council, Westport 5,000 Knock Day Care Centre 8,000 Ballycastle Social Services Council 700 (Cooker) 365 CM.A.C Ballina 2,600 Care of the Aged, Louisburgh 500 CM.A.C Charles town 350 Ballycroy Social Services 400 Castlebar Travellers Support Group 1,000 Westport Communiry Pre-School, McConville Park, Westport 1,000 Ballinrobe Community Playgroup, Qzanam House, Abbey St., Ballinrobe (£100 for Parent & Toddler Group) 900 St. ]oseph's Playgroup, Ballina 940 Ardnaree Community Playgroup, Ballina 1,585 Castlebar Social Service Playgroup 1,050 St. Lucy's Playgroup, Newport, County Mayo 1,110 St. Tiernan's Playgroup, Ballina Rd ., Crossmolina 700 Charles town Community Playgroup, Kiltimagh 640 (Fee for Special Helper) 300 Keel Community Playgroup, Keel, Achill 350 Neale Community Playgroup, Neale, Ballinrobe 1,690 Taugheen Community Playgroup, Claremorris 380 Happy Hours Pre-School Playgroup, Castle bar 985 Louishurgh Communiry Playgroup, Loui sburgh 460 Foxford Community Playgroup, Foxford 1,010 St. Bernadette's Pre-School Playgroup, Ballina 1,800 St. Colman's Playgroup Claremorris 800 (Fee for Special Helper) 528 Mulranny Community Playgroup, Mulranny 400 Aughagower Pre-School Playgroup, Westport 635 Irish Pre-School Playgroup Association 200 (Toy Library) 1,000

81 Ballinrobe Travellers Playgroup, Ballinrobe 500 Killeen Community Playgroup, Killadoon, Louisburgh 580 Ballyglass Community Playgroup, Ballyglass, Clogher, Claremorris 400 Montes ori School, Claremorris (Fee for Helper) 192 Carra Youth Club, Convent of Mercy, Ballina 360 National Advisor, l.P.P.A., Dublin 8,000 SUB-TOTAL 193,533

GRAND TOTAL 1,110,148

WESTERN CARE ASSOCIATION, BALLYHAUNIS

BALLYHAUNIS TRAINING CENTRE

2. National Lottery:- The Government makes available a block allocation from National Lottery funds each year to as ist community based projects which have been assessed by the Board. Grants are allocated to projects under the headings: mental and physical handicap, the elderly, psychiatric se rvices, child se rvices, per onal ocial services (including information and counselling. A block allocation of £192,000 from the Nati onal Lottery was made available for 30 community based projects in the Western Health Boa rd area Juring 1992 as follows:_

82 ~

Organisation Purpose of Grant Amount in £'S

Coiste Cabhrach , Carna Day Service for Elderly ,000 Samaritans, G alway Provision of Counselling Service 3,000 W est of Ireland Cardiology Foundation Employment of Ass istant Fundraiser 10,000 Galway Rape C risis Centre Provision of Counselling and Support Services 5,000 O rder of Malta Replacement of Mini - Bus 5,000 Galway Diocesan Youth Services Provision of Services to Youth 5,000 Ballinasloe Social Services Contribution towards clearing Council outstanding debts 7,000 Galway County Association fo r Mentally Handicapped C hildren Replacement of Furnishings,e tc 10,000 Portumna Day Care Services Provision of Day Care Centre 15,000 Mental Health Association , Galway Furnishing Flats in Galway C ity 10,000 Mental Hea lth Association, Loughrea Upgrading Mental Health Centre 2,000 Ir ish W heelchair Associati on Establishment of Home Care Attendant Scheme 5,000 National Council fo r the Blind Mobility Training, Blind & Phys icall y Handicapped 10,000 Cerebral Palsy Ireland Services for Physicall y Handicapped 10,000 Multiple Sclerosis Society Provision of Holiday Service 5,000 Western Care Associati un Renovations and provision of Dwelling for 6 young adults 15 ,000 O'Dwyer C heshire Home, Bohola Prov ision of Medi c Bath 4,000 Mental Health Association , Castle bar Refurbishment of G roup Home 8,000 T ourmakeady Day Care Committee Day Care Services 3,000 Buddy Bear Trust Services to Children with Motor Disorders 3,000 Ballina Invalid Residenti al Care G roup Repairs to Roof of Res idence 10,000 Ardnaree Community Pre - Prov ision of Pre-School Playgroup School Playgroup, Ballina Service 3,000 BCl llinrobe Social Services Upgrad ing of recently acquired bu ildi ng for provision of social services 5,000 Family Reso urce Centre, Provision of Equipment for Ballina proposed Centre 5,000 Achill Day Care Cummittee Provision of Day Care Facilities 5,000 Ment,d Health Association Development of Branches in Ro,cnmmon Roscommon N

------~------83 ------Other Developments

84 Galway Family Guidance Institute

Statistics for the year 1992 are presented in the usual format on the following pages. These figures provide a detailed analysis for the three categories of clients and comparative figures for the two previous years are also included. The figures give details of the number of consultations during the year, referral sources, the number of consultations with clients and the areas of origin of clients.

Client Number:- The total number of new clients was 526, some twenty more than each of the two previous years. It would seem that the intake of new referrals has levelled off and the number of around 500 per year is manageable in present circumstances. The total number of consultations (2,112) has not varied much either when compared to previous years.

Referral Sources:- Since the Institute opened self referrals have consistently topped the list and, until a few years ago, referrals from the clergy came in second place. In the last two years however, referrals from medical practitioners (129 this year) have been the second largest number. Referrals from solicitors have doubled in the same period and this would appear to be in accord with the spirit of the 1989 Family Law Legislation.

Categories of Clients:- The number of clients seeking help for serious problems prior to marriage has grown steadily over recent years. There was a 7% increase in the number of married clients when compared with 1991. 560 persons from Galway City attended the Institute during the past year.

It would appear that there is a greater social awareness of certain risks in marriage, and there is no doubt that there is an increase of marital failure among couples getting married when young. There was a noticeable increase in such cases during the year.

Income from Fees:- Regrettably, there was a drop in income from fees during the past year. Many clients simply didn't have money, a fact which probably reflects severe financial constraints on families at the present time. None the less, this source of revenue continues to cover the ordinary operational costs of the se rvice.

Areas of Origin:- The majority of referrals came from Counties Galway and Mayo with only a small number from Roscommon. Co.Clare, being a nearer area, usually makes a sizeable demand on the service. There has ge nerally been a sizeable number of referrals from places further afield such as Limerick, Athlone and the Sligo-Longford areas.

STATISTICS 1990 1991 1992

Total no. of consu ltations 1788 2059 2112 Total no. of referrals 422 481 536 Total no. of clients 744 786 850 Total no. of new clients 508 507 526

85 CATEGORIE OF CLIENTS

Married clients ...... 606

(a) Both partner attended (360) (b)One partner attended (246)

Clients contemplating marriage (Both attended - 21 couples) ...... 42

Clients contemplating marriage (One attended) ...... 84

Dependents ...... 75

Professional clients ...... 43

Referral Sources 1991 1992 1993

Self 150 186 204 Clergy 97 91 94 Doctor 74 120 129 23 Waterside House 21 21 Solicitor 23 25 49 11 Social Worker 12 10 9 C.M.A.C 8 8 Social Services 5 4 4 3 Marriage Tribunal 9 5 1 Community Welfare Officer 6 3 2 Court 3 2 2 4 Public Health Nurse 8 Rape Crisis Centre 1 - - 3 Women Hurt By Abortion Service 5 4 536 Total 422 481

Analysis of Client Consultations:

This analysis is done for the following categories of clients and indicates involvement in terms of frequency of consultations:- a) Those contemplating marriage where only one of the partie ought consultation; b) Tho e contemplating marriage where both partie attended; c) Consultations with married clients:

86 Category (A): 84 clien ts con templating marriage where only one party attended

Frequency C onsul tat ions

40 x 1...... 40 13 x 2...... 26 10 x 3 ...... 30 7 x 4 ...... 28 3 x 5...... 15 3 x 6 ...... 18 3 x 7...... 2 1 3 x 8 ...... 24 1 x 9 ...... 9 1 x 10 ...... 10

T OTAL ...... 22 1

Category (8): 42 clients contemplating marriage where both partners attended - 21 couples

Frequency Consultations 3 x 1...... 3 10 x 2 ...... 20 3 x 3 ...... 9 3 x 4 ...... 12 1 x 8 ...... 8 1 x 9 ...... 9 1 x 10 ...... 10 1 x 13 ...... 13

T OTAL: ...... 84

O TE: These clients were seen separately and together fo r assessment but these multiple interviews were calculated as one con ultation.

Category ( ): 531 Married client

IndiVIdual consultation with either pouse ...... 1298 Jl)int consultations involving hoth 'pou e ...... 346

Frequency Consultations 143xl ...... 143 71 x 2...... 146 49 x L ...... 14 7 4) x 4 ...... 172 26 x '1 ...... 130 27 x 6 ...... 162 17x7 ...... 119 Il x S ...... 0 12 x 9 ...... 10 3 x 1 ...... 30 ~ xii ...... 55

R7 4 x 12 ...... 48 3 x 13 ...... 39 6 x 14 ...... 84 2 x 15 ...... 30 1 x 16 ...... 16 lx17 ...... 17 2 x 18 ...... 36 2 x 19 ...... 38 1 x 20 ...... 20 1 x 24 ...... 24

TOTAL: ...... 1644

Consultations with Professional People:

Clergy ...... 76 Solicitors ...... 3 7 G.P...... 29 Social Workers ...... 7 Others ...... 14

Grand Total of Consultations: Married Clients ...... 1,644 Clients Contemplating Marriage - ...... One Party Attended ...... ···· ...... 221 Clients Contemplating Marriage - Both Parties Attended ...... 84 Professional Consultants ...... 163

TOTAL ...... 2,112 Information Technology

The Community Care Information Technology Steering Committee which was set up to advise on the development of computer systems in the Community Care Programme met on four occasions during 1992. The following is the position with regard to the various Community Care Information Technology Projects as at 31st December 1992.

1. Environmental Health Database:- Currently under test in Community Care Galway and will be implemented in all three counties during 1993.

2. Asset Tracking Sys tem:- This sys tem is running on P.e. in Community Care Mayo and is being considered by Community Care Galway and Roscommon.

3. Public Health Nurse Management System:- Specification has been prepared and awaiting Management Services Department approval.

4. Speech Therapy System:- System de igned for P.C's to be implemented in 3 Community Care Areas during 1993.

5. Phys ical Handicap Register:- A data se t has been prepared and will be ready fo r implementation in 1993.

6. Mental H andicap Register:- System maintained by Brothers of Charity se rvices at Woodlands, Renmore, and recognised as the best of it's kind in the country, is full y operational and available to the 3 Community Care Areas.

7. Medical Cards System:- This sys tem is now implemented in all three counties.

8. Social Work Registers:- pecifications have been produced and are currently being examined.

9. Cost ~I()nitming ystem:- This system is now implemented in all three counties.

During 19:2 the pr~)gramme completed and submitted an Information Technology Training Strategic Plan for all ::.taff categories in each location. It wa also repre ented on the Health Care Information System ~~tanJards Committee which met on two occasions during 1992.

------9 ------Quality Assurance

The Community Care Programme's commitment to the management of quality in health service provision continued in 1992. A small team was appointed to address quality assurance matters generally with a particular responsibility to identify areas within which achievement of the Quality Mark or the ISO 9000 standards might be appropriate. Co-ordinating committees were also set up to advise on quality assurance matters in respect of the Public Health Nursing and Foster Care Services specifically. A highlight during 1992 was the awarding to Aras Attracta , Swinford, by the Irish Quality Association of the 'Q' mark for the quality of it's services. Aras Attracta is the first heath care facility in Ireland to secure this prestigious award which entitles them to display the 'Q' mark insignia. The award was gained as a result of the enthusiastic and unremitting dedication of all staff members at Aras Attracta who were highly commended by the members of the Board at it's meeting held there in September 1992. It is also noteworthy that the catering contractors at the centre, Messrs. Gardner Merchant were also successful in obtaining the 'Q' mark.

Community Care Standing Committee

The following reports presented to the Community Care Standing Committee were adopted by the Board during 1992

1. Special Housing Aid for the Elderly Scheme. 2. Services for Physically Handicapped Adults. 3. Child Care Act, 1991. 4. Child and Adolescent Psychiatric Service. 5. Autism Services. 6. Green Paper on Mental Health. 7. Community Care Annual Report 1991 8. Combat Poverty Agency - Annual Report 1991 9. Holiday Services for Travelling People. 10. Ophthalmic Services 11. Violence in the Home - Services for Women 12. Statistical Information on Social Welfare Services 1991 13. Hygiene Standards in School. 14. Infe~tious Diseases.

90 HEALTH CENTRES AND CLINICS PROVIDED 1971/1992 GALWAY COMMUNITY CARE AREA

Location Date Cost: 1) New Health Centres at Camus, Attymon, Tully and Ballymacward 1974/77 51,000 2) Extensions and Improvements to Health Centres at Inishmaan, Turloughmore, Rosmuc Mountbellew, Oranmore, Moycullen, Athenty, Abbeyknockmoy, Loughrea, Ballygar, Inisheer and Gort 1974/77 130,544 3) Grant towards provision of Social Service Centre at Tuam 1976 16,000 4) Health Centre at Kilkerrin 1977 13,000 5) Health Centre at Ballinasloe 1977 14,000 6) Purchase and adaptation of premises - Health and Social Services Centre at Loughrea 1978 50,000 7) Health Centre at Mervue 1978 43,500 8) Nurses' Residence at lnisheer 1978 10,000 9) Extension to Health Centre at Kinvara 1979 13,500 10) Health Centre at Laurencetown 1979 18,500 11) Killimore Health Centre (new) 1981 17,196 12) Wood ford Health Centre (new) 1981 37,269 13) Carraroe Health Centre (new) 1981 74,926 14) Craughwell Health Centre (new) 1982 27,267 15) Shantalla Health Centre (extension) 1983 26,387 16) Ballinasloe Health Centre (extns.2 No) 1983 38,030 17) Turloughmore Health Centre{extension) 1983 25,472 18) Lettermore Health Centre (new) 1984 27,237

SUBTOTAL Forward 633,828

Location Date Cost:

19) Mountbellew Health Centre (extension) 1984 10,832 20 ) Tuam Hea lth Centre (extension) 1986 100,419 21) Headford Health Centre (Extension) 1986 73,074 22 ) Community Care H.Q.{Extension) 1987 301,570 23) O ughterarJ Health Centre (new) 1987 101,900 24) Carna Hea lth Centre (new) 1988 74,493 25) C li fden Hea lth Centre (new) 1988 157,108 SUB-TOTAL - 1,453,224

91 (B)MAYO COMMUNITY CARE AREA

Location Date Cost: 1) Mobile C linics at Hollymount, Kilkelly and Geesala 1977 20,970 2) Health Centre at Clare Island 1977 16,200 3) Health Centre at Bellmullet (included with cost of Aras Deirbhle) 1975 - 4) Health Centre at Ballycastle 1979 18,300 5) Health Centre and General Practice Premises at Ballina 1980 113 ,000 6) County C linic Castlebar: Extn. No.l Jun 1981 23,940 Extn. No.2 Oc 1981 6,606 7) Crossmolina Health Centre (new) 1982 26,207 8) Shrule Health Centre (new) 1982 18, 742 9) Killala Health Centre (new) 1983 51 ,001 10) Hollymount Health Centre (new) 1983 32,379 11) Kilkelly Health Centre (new ) 1983 30,654 12) Ballindine Health Centre (new) 1984 25,153 13) C laremorris Health Centre (extension) 1985 29 ,499 14) Ballina Health Centre (extension) 1986 141 ,074 15) Geesala Health Centre (new) 1988 32,288 16) Achill Health Centre (extension) 1990 8,778 17) Kiltimagh Health Centre (upgrading)* 1992 32,000 18) Aughleam Health Centre (upgrading) 1992 15,000 19) Westport Health Centre (upgrading) 1992 10,000 20) County Clinic, Castlebar (Reorganisation) 1992 9,000 21) Ballina Health Centre (upgrading) 1992 6,000 22 ) Killala Health Centre (refurbishment) 1992 5,000 23 ) Shrule Health Centre (upgrading) 1992 4,500

SUBTOTAL 676,2 91

*International Access Symbol was awarded to Kiltimagh Health Centre

C) ROSCOMMON COMMUNITY CARE AREA

Location Date Cost:

1) Health Centre at Elphin 1975 ,000 2) Modernisation of other Health Centres 1975 10,200 3) Ballaghadereen Health Centre (new) 19 1 51,979 4) Strokes town Health Centre (extension) 1983 24,022 5) Keadue Health Centre (extension) 1983 1,730 6) Castlerea Health Centre (new) 19 4 0,692 7) Kil toom (purchase of premises ) 1985 37,000 8) Brideswe ll Health Centre (new) 19 7 47,570 9) Boyle Health Centre (extension) 1988 30,063

SUB-TOTAL 29 1,256

92 SUB-TOTAL: Galway 1,453,224 Mayo 676,291 Roscommon 291,256

GRAND TOTAL 2,420,771

91

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