The Irish Doctors for the Environment (IDE) have joined medical professionals from across the Nordic region in issuing a stark warning about the dangers of climate change, declaring that “the climate crisis is a health crisis.” The joint statement, made in collaboration with the Nordic Doctors for Planetary Health and Climate Action, calls for urgent measures to protect public health from the escalating effects of global warming. It was published in the Scandinavian Journal of Public Health.

According to the statement, the medical professionals emphasise that climate change is already exacerbating existing health issues, increasing the spread of infectious diseases, worsening respiratory conditions due to air pollution, and contributing to mental health problems. “The health sector must take a leadership role in addressing climate change,” the statement asserts, highlighting the need for rapid policy action to mitigate environmental damage.

The doctors also stress the need for governments to transition away from fossil fuels, citing the health benefits of cleaner energy. “Reducing emissions will not only slow climate change but also lead to immediate health improvements, including lower rates of heart disease and respiratory illness,” they argue.

In addition, the statement calls for increased investment in sustainable food systems, active transport, and policies that prioritise both human and planetary health. “A healthy planet is the foundation of a healthy population,” the doctors warn, urging policymakers to act decisively.

The joint statement comes amid growing concern within the medical community about the link between environmental degradation and public health crises. The IDE, along with its Nordic colleagues, are urging healthcare professionals worldwide to advocate for urgent climate action as a matter of public health policy.

Posting bowel cancer screening kits directly to people who are eligible for BowelScreen can boost participation rates, according to a new RCSI study.

The research, supported by the HSE National Screening Service’s BowelScreen, showed a 6 per cent increase in screening uptake among people who were sent a postal kit, a strong improvement given the simplicity of the intervention. 

The study, which was funded by the Irish Cancer Society, offers a strategy to enhance prevention and early detection efforts for one of Ireland’s most common cancers.

With Bowel Cancer Awareness Month starting today, the publication of this study is timely, highlighting the need to increase screening participation across the country. In Ireland, bowel cancer is the second and third most common cancer among men and women respectively, with around 2,500 new cases each year. Screening can help prevent bowel cancer and detect it before the cancer progresses to later stages when treatment is not as effective. Despite the proven benefits of screening, BowelScreen’s screening uptake is approximately 10 per cent below comparable bowel screening programmes in Europe.

The BowelScreen approach requires first-time invitees to request a home screening kit on receipt of their invitation to take part – an important step to confirm consent to participate in screening and personal details, and reduce potentially costly kit wastage, but a step that may deter participation.

The study, led by Dr Nicholas Clarke at RCSI’s School of Population Health, tested two interventions to encourage more people to take part. 

Rather than waiting for people to request a kit, the study sent kits automatically to those who had not responded to the initial invitation letter. This intervention alone resulted in a 6 per cent increase in participation rates.

Additionally, the study introduced a more personal reminder letter co-written by a patient and public involvement (PPI) panel. This revised version of the letter addressed common concerns about the screening process identified from previous research conducted by Dr Clarke and incorporated personal insights from the panel aiming to reduce hesitation and improve response rates.

Findings indicated that this intervention had the most impact on women from lower socio-economic areas when sent alongside the screening test kit. 

The study highlights the need to remove barriers to bowel cancer screening, particularly among men and those in socioeconomically disadvantaged areas, where participation remains lowest. Participation in screening can reduce the risk of a cancer diagnosis and even prevent it by detecting polyps that could progress into cancer if left unchecked. 

“This research highlights simple yet effective changes that can significantly increase participation in bowel cancer screening,” said Dr Clarke, Research Fellow and senior author on the paper. “By making the process easier and addressing concerns upfront, we can save more lives. However, based on 2020/21 data, which was the latest available when the research was carried out, overall screening uptake still remains lower than the EU’s recommended uptake levels of at least 65 per cent. Indeed, evidence has shown that few screening programmes in Europe have achieved uptake rates above 50 per cent. Continued implementation of screening and further refinements to understand what works best and for whom are essential to ensure more people benefit from cancer prevention and early detection.”

“The continued implementation of these small changes can increase bowel screening uptake and ultimately lead to better bowel cancer prognoses and mortality outcomes overall. It is hoped that further research will help improve understanding of the lack of participation among certain groups, so that all communities can access the lifesaving benefits of BowelScreen across Ireland.”

BowelScreen Programme Manager, Ms Hilary Coffey Farrell, said: “We are marking Bowel Cancer Awareness Month in April by encouraging all people aged 59 to 70 to reduce their risk of bowel cancer developing by choosing bowel screening. 

“Uptake rates in BowelScreen are a priority for us and we are focused on working to remove any possible barriers to bowel cancer screening, particularly among men, and those in socioeconomically disadvantaged areas, where participation remains lowest. 

“Our partnership work on this research project will add to the evidence that supports our decision-making around measures to increase equitable uptake, whilst continuing to ensure we meet our population health aims; balance the benefits and harms for our participants, be cost-effective, and enable more people to choose screening.”

The HSE’s BowelScreen programme offers screening every two years for people between the ages of 59 and 70. Visit hse.ie/bowelscreen to register for your screening today.

The research is supported by Irish Cancer Society and the National Screening Service through the Research Grant SCR20CLA and supported in part by grants from the Health Research Board and Research Ireland.

The College of Psychiatrists of Ireland has called for a major overhaul of the management and governance of HSE Child and Adolescent Mental Health Services (CAMHS) across the country.

CAMHS provide mental health treatment services for children and young adults with moderate to severe mental illness.  The service has been involved in significant controversy in recent years, including serious allegations of children being harmed in the care of certain CAMHS services and widespread concerns that lengthy waiting lists are leading to unacceptable delays in the provision of vital care for young patients.

In response, the College formed a special working group to study reforms in the services which has led to the publication of a comprehensive policy document today.

Dr Patricia Byrne, Chair, Faculty of Child and Adolescent Psychiatry, said that reform of CAMHS was now critically urgent.

“CAMHS in Ireland has been beset by chronic underfunding and under-resourcing.  There have been failures to provide fit-for-purpose governance systems to facilitate CAMHS development in line with the Government’s mental health policies (A Vision for Change and Sharing the Vision).”

“The Mental Health Commission reports identified national deficits in team staffing, lack of minimal required resources to facilitate service delivery, failure to implement national policy objectives for comprehensive CAMHS provision, and failures at a national HSE level to respond to risks escalated through the HSE systems,” she said. 

“This has led to variable and, at times, a suboptimal service for children and adolescents who suffer from severe mental illness.  Sadly, this has resulted in negative impacts in service experiences for young people and families who require our services, and for the frontline staff trying to deliver care. As such, a major reform of the service is of critical and unparalleled importance to the wellbeing of those patients and their loved ones.

 “As a developed nation with a healthy budget surplus, it is unconscionable in 2025 that Ireland cannot adequately treat our very vulnerable young people who need help so badly.  Mental health problems in childhood and adolescent are associated with detrimental impacts on developmental outcomes in young adulthood.  Patients, their families, and the doctors and other healthcare staff who work within CAMHS deserve so much better.”

 Key recommendations that the College is proposing include:

– Specialist (Consultant) child and adolescent psychiatrists must lead each CAMHS team.

– A new senior management role, the Clinical Service Manager (CSM), should be created at a team and regional level. The CSM would have a critical role in team co-ordination, service audit and performance review and in facilitating service development at a local and regional level.

– A nationwide network of CAMHS Clinical Directors is needed to fulfil clinical and managerial roles for teams, support regional development of services, and establish two-way links with national management teams.

– Both the Clinical Director and a Clinical Service Manager representative must have membership of the Regional Area Mental Health Management Team to represent CAMHS.

– All staff working in CAMHS should receive specialist CAMHS-specific training to ensure optimal standards of care.

– All members of the CAMHS multidisciplinary team must have clearly defined roles and be clinically accountable to the specialist consultant psychiatrist as the clinical lead.

 Dr Lorcan Martin, President of the College and Consultant in General Adult Psychiatry, said: “The recommendations proposed outline radical new governance and management structures, and they will lay solid foundations for the development of a world-class mental health service of which we can all be proud.”

The College called on the Government to act urgently to implement the recommendations contained in the proposal.

The paper is available here: https://mcusercontent.com/ea59553be3355b7972cbfa3a1/files/4fe3a851-21b3-1961-8ea311328ad7dd8a/CPsychI_A_model_of_CAMHS_Governance_amp_Mgt_Structures_final_.pdf

The publication of the EU Regulation on the European Health Data Space (EHDS) is an “important milestone” according to Minister for Health, Jennifer Carroll MacNeill.

The EHDS is set to provide individuals with better access to their personal electronic health data and enable health professionals to access relevant health data for healthcare delivery across the EU.

This will be achieved by providing a common governance framework and harmonised infrastructure for the safe and secure exchange of electronic health data across the EU.

“Publication of the EHDS Regulation is another important milestone in creating a fit for purpose national health information system that enhances patient care and treatment as well as supporting better planning and delivery of health services into the future,” said Minister MacNeill.

“In preparation for the EHDS Regulation, Ireland has been proactively working with our European counterparts to provide the foundations for this regulation.” 

Implementation of the EHDS Regulation will place obligations on member states beginning in 2027 and continuing through to 2031.

“While giving full effect to the EHDS Regulation will take a number of years and follow a phased implementation timeline, the first steps have already been taken through initiatives such as the recently launched HSE Health App and the procurement of a shared care record.”

The health measures in the new Programme for Government need a “detailed implementation plan”, with a corresponding commitment to funding, according to IMO President Dr Denis McCauley.

Dr McCauley congratulated the new Minister for Health Jennifer Carroll MacNeill on her appointment and said that the union looked forward to meeting her soon, “to start work on bringing the aspirations of the recently announced Programme for Government to reality”.

“However, it is important the new Minister appreciates that we must very quickly see a detailed implementation plan with a corresponding commitment to funding. Doctors and other healthcare professionals are struggling to deliver care in environments that are under-resourced, under-staffed and under pressure.”

Dr McCauley, who is also a GP, said that patients around the country are facing problems accessing care in general practice, mental health services, acute hospital services or community services.

“The IMO has long campaigned for adequate capacity, a funded medical workforce plan and investment in general practice – we will be seeking to engage with Minister Carroll MacNeill on the implementation of these targets and a realistic multi-annual funding programme for our health services that meets the needs of the population and allows doctors to deliver timely care.”

Last week the IMO criticised the HSE National Service Plan 2025 (NSP) claiming it confirms an “effective recruitment freeze remains in place”. The Organisation also warned the NSP will see “no significant increase in capacity with just 300 beds planned for the coming year”.

The HSE National Service Plan 2025 has been published today. The plan sets a range of health and social care services that will be provided within the allocated budget of €26.9 billion, a €1.6 billion increase on 2024. This includes a €297.8 million investment in new service developments including enhancing mental health, older persons, and disability services.

Outgoing Minister for Health Stephen Donnelly said the service plan will “shortly be supported” by a capital plan involving approximately €1.4 billion for infrastructure and equipment across the health service. Some €190 million of the capital plan is specifically for digital and ICT infrastructure.

Speaking about the HSE’s priorities this year, Mr Ciarán Devane, HSE Chairperson, said: “The board’s overarching objectives for 2025 are to support improved efficiency and increased productivity, maintaining the ongoing focus on improving the quality of care, and continuing the shift to providing more care closer to people’s homes.

“The publication of this plan coincides with the 20th anniversary of the establishment of the HSE. During this time Irish health and social care services have been significantly reshaped to improved health outcomes for the people of Ireland.

“While we have seen significant progress over the last three years, a priority for the HSE in 2025 will be to further reduce waiting times. We will place a specific focus on maximising an integrated approach to care delivery across community and acute settings, enabled through our new health regions.”

Mr Bernard Gloster, CEO of the HSE, said: “At a time of unprecedented demand for services we must ensure that our funding delivers more care and services to the people of Ireland, reduces waiting times and improves health outcomes of the population. Our priority in 2025, therefore, must be a relentless focus on productivity and changed ways of working. Expanding our workforce, improving our buildings, adding new capacity and seeing more people than ever must all be pursued at the same time.

“The digital opportunities for the health service is one of those changes and a major priority as we face new challenges and ensure we can provide the health service the country needs and deserves. I am delighted that the business case for this national electronic health record is progressing and hope it will conclude to next stage approval in 2025.  However, in the meantime there are critical steps along the way to this end, such as achieving a summary care record, HSE patient App and use of technology to develop virtual care. Digital for Care 2030 requires us to now deliver on significant steps over each of the next few years.”

Six new health regions have been established. According to the HSE, health and social care services will be planned and delivered around the specific needs of local populations leading to “better co-ordination of care and access to services”.

“This offers the opportunity to take the next step in creating a modern, value-based health and social care system. Finalising the change from the traditional operational centre of the HSE to a visible regional operating system overseen from the Centre is a key target by 1 March 2025. This will mark the completion of the most significant structural reform of the HSE and how it operates since the organisation first came into being,” stated the Executive.

A copy of the HSE National Service Plan 2025 can be accessed here: https://about.hse.ie/publications/hse-national-service-plan-2025/

There was a 33 per cent increase in the number of cases reported last year to the National Safeguarding Office compared to 2022.

The figure is contained in the new 2023 National Safeguarding Office Annual Report, which found the total number of safeguarding concerns reported to the HSE was 18,290.

Of this number, 12,269 concerns were regarding adults 18-64 years of age, and 5,582 were concerns regarding adults 65 and over.

Referrals from service settings such as residential and nursing homes increased by 4,000, last year.

Mr Tim Hanly, HSE National Safeguarding Office, said the report is a “vital reminder” of the importance of adult safeguarding across health and social care services.

He noted that the increase in adult abuse reports to the HSE last year was “the most significant year-on-year increase since safeguarding and protection teams were set up by the HSE in 2015”.

“Reports are significantly increased across our service settings, however detection and response to adult abuse especially elder abuse in all settings still remains challenged by a deficit in awareness and understanding – perhaps even recognition of the issue – among staff, families and communities.”

Ms Amanda Casey, HSE Chief Social Worker, said: “Adult safeguarding is about providing supports for all adults at risk to live their lives free from harm and abuse.  This requires all of us to take steps to ensure that people using our services, and those who care for them, are aware of their rights and are supported to raise concerns.  We do this by raising awareness and providing training for our staff about signs and indicators of abuse and by supporting them to report concerns.”

The report can be accessed here: National Safeguarding Office Annual Report 2023

The Government has  announced “a record” €25.8 billion health budget “to support the continued delivery and expansion of quality, affordable healthcare services in 2025”.

According to the Department of Health the funding represents an overall increase of €2.94 billion on the January 2024 allocation.

It will provide for more than 3,300 additional staff, deliver 335 additional hospital beds, “expand services, deliver increased productivity and continue the reductions in waiting lists and trolley numbers”.

The 2025 health budget includes €1.2 billion allocated for existing level of service, €1.5 billion additional funding for 2024 pressures and €335 million in additional new measures.

According to the Government the 2025 budget also includes  €33 million investment “to provide more and better cancer services”, publicly funded HRT products for women experiencing symptoms of menopause and extension of publicly funded IVF as part of €35 million measures for women’s healthcare.

On the budget announcement Minister for Health Stephen Donnelly said, “whether it’s an appointment with a GP, a home care package for a loved one, an X-ray or MRI, quick access to emergency care or a minor injury unit, an appointment with a hospital consultant or surgery, Budget 2025 is all about making this a reality for more and more patients and families”.

“We are living longer and living better, but our growing and ageing population place additional demands on our services. We continue to respond to these challenges, and we are placing a strong focus on more productivity alongside investment in increased capacity and in workforce planning to ensure we can meet the needs of our healthcare service into the future.”

In response to Budget 2025’s investment in cancer care, Irish Cancer Society CEO, Ms Averil Power said the charity weclomed “the priority given to people affected by cancer in Budget 2025. The investment provided for in this Budget will benefit people with cancer and their families all over the country”.

She added that “hopefully, this is the beginning of a new approach to funding cancer care that will see sustained increases in ringfenced funding for cancer services going forward”. 

“With cancer cases expected to double by 2045, continued increases in investment will be required to meet increased demand and ensure that Irish patients benefit from advances in cancer research and services.”

A new guideline has been launched by the HSE National Cancer Control Programme (NCCP) to support patients who have been diagnosed with melanoma skin cancer. Around 1,100 people are diagnosed with the disease annually in Ireland, and melanoma has become increasingly more prevalent in recent years.

Dr Eve O’Toole, Head of Evidence and Quality Hub in the NCCP, said: “The purpose of the guideline is to provide evidence-based recommendations on the staging and surveillance of patients with cutaneous melanoma through the integration of the best research evidence with clinical expertise, patient values, and experiences.

“Knowing what is happening now and what will be happening next can provide reassurance to patients that an optimum plan for them is in place. The guideline describes what tests patients should have and for how long surveillance should continue.”

The guideline will help provide information for treatment planning for people with melanoma and help to detect any recurrence or relapse early, leading to prompt treatments and interventions. It was developed in consultation with oncology patients, doctors, nurses, and researchers with an overall aim to improve the quality of clinical care for patients and optimise patient experience. The document will also provide reassurance for patients that they are being monitored based on the best current evidence.

Melanoma cancer patients and members of the Guideline Development Group Kay Curtin and Miriam Staunton said: “It was great to be involved in the process of creating the guidelines we felt the patient voice was heard. Melanoma cancer guidelines are essential as they give patients an ability to advocate for themselves and help ensure consistency across Ireland’s cancer centres.”

Dr Sinéad Field, Consultant Dermatologist and Chair of the Clinical Guideline Development Group, added: “Melanoma is on the increase in Ireland and while it is more common in people over 50, you can get it at any age. The new National Clinical Guideline for Radiological Staging and Surveillance of Patients with Cutaneous Melanoma will support people who are undergoing or have had treatment.

“Staging scans help to determine if a patient’s cancer has spread or is likely to spread to other parts of the body, or recur. This knowledge is useful as it provides an opportunity to optimise the patient’s treatment plan. Surveillance of patients after they have finished their treatment is to check for a recurrence or relapse of their cancer. This is useful as it provides an early opportunity for treatment.”

The full guideline can be accessed at: https://assets.hse.ie/media/documents/ncr/20240513_National_Clinical_Guideline_Cutaneous_Melanoma_V0.pdf.

The HSE is seeking additional funding to include chronic kidney disease (CKD) in the GP chronic disease management (CDM) programme in 2025, it has confirmed. The prevalence of CKD is significantly increasing in Ireland. Some 15.6 per cent of people aged 50 and over have CKD, but most are unaware, according to research published last year by TILDA and the National Renal Office (NRO).

The HSE has stated that recommendations from a review of the NRO are still being considered in the context of health service structural changes. The review was commissioned to examine the current and future work of the NRO, which was established in 2009 before the initiation of the HSE clinical programmes. Its original remit was end-stage kidney disease. The office now requires support for work in other areas, including preventative nephrology.

Commenting on the inclusion of CKD into the CDM programme, the Irish Kidney Association said: “We need to see the Government include provision for this positive development in the forthcoming Budget. We have seen the benefits for cardiac care as well as diabetes and hypertension management. Including CKD will be a significant move towards proactive health management in the general population. Remember, one-in-10 in the population has CKD, including one-in-seven of those over the age of 50.”

General practice completed 99,098 reviews of patients enrolled in the CDM programme in the first two months of 2024, according to figures provided to NiGP. The Department of Health also confirmed that it believes the programme is “the main contributing factor” in a reduction of chronic disease-related hospital admissions in recent years.

“The CDM programme forms part of the wider enhanced community care programme which has improved patient care and provided ongoing improvements to how health services are delivered,” said the Department’s spokesperson.

This reduction in hospital admissions was discussed at the Sláintecare programme board meeting in April. Board members were shown data that indicated a 16 per cent reduction in chronic disease-related hospital admissions as compared to a 3.5 per cent reduction in all other medical admissions per 100,000 population between 2019 and 2023.

The meeting was also told that 91 per cent of patients on the programme “are now fully managed routinely in primary care” and are not attending hospital for ongoing management of their condition. The CDM programme commenced in 2020. It has been rolled out on a phased basis to adult patients with a medical or GP visit card. Approximately 94 per cent of eligible GPs have signed up to providing the CDM programme.

The Irish Nurses and Midwives Organisation (INMO) has served notice of industrial action on HSE West and North West. The notice follows voting by public health nurse management in Galway over the HSE’s failure to implement recommendations to help ease the “extreme pressure” on staff in the area.

INMO Professional and Regulatory Officer David Miskell described the current pressures being experienced in the region as “intolerable”. He stated that patient care is “falling short”, and that the health and safety of INMO members practising in public health in Galway is now “significantly compromised” as a result of the ongoing challenges. “Public health nurse management in Galway are at a juncture now where they feel like they have no other option but to engage in industrial action,” he said.

Mr Miskell compared the Galway catchment of 285,000 people to the national average of 150,000, adding that the region is “unique” in view of its “large geographic area with an urban-rural mix, island populations, and a growing population”.

“Despite local engagement and two conciliation conferences that took place under the auspices of the Workplace Relations Commission, no meaningful resolution has been reached, with the additional resources required to maintain safe and effective care for the people of Galway not being put in place.

“HSE West and North West must now urgently and meaningfully engage with the INMO in relation to the matters at the centre of this dispute. The provision of putting all resources that are necessary to provide a safe public health nursing service for the people of Galway must be a priority. If the HSE fails to engage, regrettably this industrial action will escalate over the coming weeks.”

To align with National Breastfeeding Week 2024 (1-7 October), the HSE has published the Breastfeeding Action Plan Progress Report 2016-2023. Data demonstrates an 18.6 per cent increase in the number of infants breastfed at three months since 2015, and that 64 per cent of new mothers now initiate breastfeeding after birth. Other key highlights from the report include:

·        Almost a fourfold increase in the number of dedicated infant feeding specialists available to support mothers (increasing from 15-to-59 since 2017);

·        A new national infant feeding education programme underway for HSE staff;

·        Almost 22,000 queries were answered via the HSE online breastfeeding support service since 2016.

This year the theme for National Breastfeeding Week is ‘Supporting you from bump to baby and beyond’. Sheila Lucey, infant feeding specialist in West Cork, said “we are keen to encourage mums-to-be to consider preparing for feeding while pregnant” and encouraged women to contact breastfeeding specialists and attend local community groups.

“Our support groups are safe spaces for mothers at all stages, whether someone is pregnant and thinking about breastfeeding, new to breastfeeding and has questions, or having problems with breastfeeding. We are here to provide non-judgemental advice and support at each and every one of the 215 breastfeeding groups around the country. Support people are also welcome, whether that is dad, partner, granny, grandad, or a trusted friend. Take the opportunity to ask those questions or alleviate any concerns you may have.”

Skilled breastfeeding supports are available in all maternity units and hospitals, in local health services, and online at mychild.ie. Common questions include:

·        Is baby getting enough?

·        How to settle baby?

·        How to treat sore nipples?

·        How best to express and store milk?

·        Can I take certain medication while breastfeeding?

Minister for Public Health, Wellbeing, and the National Drugs Strategy Colm Burke said:“It is very positive to see that, with investment in resources in breastfeeding supports, there is an increase in the numbers of new mothers choosing to breastfeed throughout the country. The health benefits for both mothers and their infants in the short term are significant and continued breastfeeding can reduce the risk of long-term health outcomes such as obesity, diabetes, and some cancers.

“Helping more mothers to breastfeed is crucial to improve long term population health and we must continue our efforts to support parents who want to breastfeed their children. We all have a role to play to promote breastfeeding; within our communities, in public services, in the workplace, along with the invaluable support of volunteer breastfeeding groups and dedicated staff in the health service.”

The full progress report is available at: www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/child-health-and-wellbeing/breastfeeding-healthy-childhood-programme/research-and-reports-breastfeeding/.