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This article covers a recent letter presented to government by a group of medical professionals, which notes the link between health care and the climate crisis and argues that our emergence from the pandemic must be a 'catalyst for change'. It covers the key areas of safety, patient-centeredness, efficiency and equity, as it argues that a more fair and sustainable health system must be put in palce after the pandemic, and that it is more economically sustainable to make changes that would prevent future crises of this nature rather than continuing down the dangerous path we are currently on. The doctors quoted in the article feel they have an obligation to make this case to the government so as to advocate on behalf of their patients, highlighting the aspect of patient-centredness.

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Public health, social justice and sustainability must be "at the heart of Ireland's path out of the pandemic" alongside collective action to urgently address the climate and biodiversity crisis, a group of Irish doctors has said.

Irish Doctors for the Environment, a group representing more than 800 doctors and health professionals across Ireland, has called on the Government to approach the pandemic as "an opportunity for change" and a chance to build a "healthier, more just world".

In a letter sent to Government officials on Thursday to mark Earth Day 2021, the group underlined the urgent need to build a more equitable world with a functioning health system, a more secure energy supply from renewable resources and a stronger focus on the eradication of poverty, urban regeneration and liveable cities that promote social connection.

If policy makers do not prioritise these measures and instead return to business as usual another pandemic will inevitably happen in the near future, warns the group.

The letter writes that the pandemic was not a surprise and had been predicted by doctors for decades. "Pandemics arise when humans encroach on nature by changing patterns of agriculture, trade, exploitation of resources. Make no mistake, Covid is a messenger from an unhealthy planet. It has brought home to everyone how vital health is, and that no one is safe until everyone is safe."

Prioritising health and social justice also makes economic sense, notes the group, which highlighted that the cost of preventing a pandemic would be less than 5 per cent of what it could take to respond to another health crisis of this scale.

"Every decision made now will have lasting consequences for the health and lives of future generations."

Dr Ana Rakovac and Dr Rachel MacCann of Irish Doctors for the Environment outside the Convention Centre, Dublin. Photograph: Gareth Chaney/Collins

The group's letter was delivered to Dáil Éireann while deputies debated the second stage of the Climate Action Bill inside Dublin's Convention Centre. Six doctors dressed in masks and scrubs gathered outside the centre where they handed a copy of the letter to Independent TD Thomas Pringle who agreed to pass it on to the Taoiseach, the Tánaiste and the Minister for Transport, Climate and Environment.

Dr Derek Cawley, a spine surgeon at the Mater Private Hospital, who presented the letter to Mr Pringle, said scientific data shows an increasing number of vector-bourne diseases are spreading as a result of human intrusion in the wild. "This is threatening our ecosystem and threatening the human race," he told The Irish Times.

"We're at a crossroads in terms of decision-making going forward and a central part of our recovery needs to prioritise the health of our people. We are sending this message to the Government because we feel it is incumbent on us as doctors to advocate for our patients."

Dr Callum Swift, an emergency medicine registrar at Tallaght University Hospital, said the State's emergence from the pandemic should be treated as "a catalyst for change".

"We don't want to emerge from this crisis and return to the old ways, and sadly that appears to be what the world is going for. It looks like we're returning to the old normal and that's what got us into this problem."

Dr Swift called on all TDs to support the Climate Action Bill so as to ensure "transformative change across all sectors of society".

"When the coronavirus hit it was national news bulletins on a daily basis, there was collective action. We all realised the importance of doing our part and social distancing. That same level of urgency is required to address the climate crisis and biodiversity crisis."

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Covid-19 a chance to build 'healthier, more just world' - doctors

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Public health, social justice and sustainability must be "at the heart of Ireland's path out of the pandemic" alongside collective action to urgently address the climate and biodiversity crisis, a group of Irish doctors has said.

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This article discusses a recent investigation into the handling of personal information by the Department of Health, after it was revealed that the department had been using private information from doctor's records of children with autism to put together dossiers on those who had made legal claims against the State. This raises issues around the aspect of safety, regarding the security of a patient's private and sensitive information, and patient-centredness, as this goes against the supposedly trusting relationship between doctor and patient. It also could be considered under the aspect of equity, as this targets children with disabilities specifically and so could be argued that it is discriminatory treatment of a certain group.

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The Data Protection Commissioner has begun a statutory inquiry into the handling of sensitive personal information by the Department of Health.

The office has acted on its own initiative to set up the inquiry having already submitted questions to the department following a report by RTÉ Investigates last week.

In the programme, RTÉ Investigates detailed how the Department of Health has been secretly using information from private doctor consultations to build and maintain dossiers on children with autism who were involved in legal actions against the State.

A statement from DPC said the issue arose in relation to information on children diagnosed with autism who had been involved in legal actions against the State.

"The inquiry will examine whether or not the Department of Health has discharged its obligations in connection with the data processing concerned and it will determine whether or not any provisions of the Data Protection Acts and/or the GDPR have been contravened by the Department of Health in that context," it said.

Authorised officers of the DPC have been appointed to conduct the investigation.

Under the Data Protection Act, these authorised officers have the power to enter premises, search for, secure and inspect any documents if the investigation requires it.

The Secretary General of the Department of Health, Robert Watt, wrote an open letter following the report that it had not acted unlawfully.

"I would like to reassure all parents, families and interested parties that the department has never unlawfully held sensitive medical and educational information of children involved in dormant court cases," he said.

Inclusion Ireland, the national association for people with an intellectual disability, said the programme findings have "seriously damaged faith in the system among people with disabilities and their families".

Interim CEO of Inclusion Ireland Lorraine Dempsey said: "We know that 50 children are affected by this investigation, but every family who has interacted with State agencies or advocated on behalf of a child with a disability is now wondering if their information has been retained, or collated. Faith in the system has been seriously damaged by the revelations.

"We're calling for a full investigation into this practice to establish how widespread it is, how many people are affected, and if people's rights to privacy have been breached."

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DPC probe over dept dossiers on children with autism

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The Data Protection Commissioner has begun a statutory inquiry into the handling of sensitive personal information by the Department of Health. The office has acted on its own initiative to set up the inquiry having already submitted questions to the department following a report by RTÉ Investigates last week.

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People should not be deported during the Covid-19 crisis unless there is a threat to national security, the Taoiseach has said in the Dáil.

Micheál Martin told Social Democrats Wicklow TD Jennifer Whitmore that "deportation is a part of our wider migration management programme but in the context of Covid, we have obligations to the health of people, irrespective of status".

He said those obligations applied for example "in terms of sending someone back to a red zone" where Covid-19 is prevalent.

Ms Whitmore had raised the case of a constituent who has to present himself on Thursday for deportation.

"It is two weeks out from Christmas, we are in the middle of a pandemic and this man has lived in the country for 14 years contributing to his community during that time. It is inhumane to deport someone after 14 years of living somewhere," she said.

Ms Whitmore said that her constituent and many others "are being caught in this limbo land between an old system that we all agree is not fit for purpose and the Government has committed to reform and those reforms being formalised and being put in place."

Mr Martin said that "while wanting to retain the capacity in terms of threat to national security or other factors, we would have a stay on deportations".

Since March just four people have been deported although 469 deportation orders have been issued and three of them were issued before the start of the pandemic.

Later speaking in the Seanad Minister for Justice Helen McEntee said she had asked officials to review the issuing letters of refusal to stay in the State and letters with deportation orders.

None had been issued to those in the international protection process since the start of Level 5 restrictions.

And no deportations had occurred since March for people who were unsuccessful in their application for international protection in the State.

Ms McEntee added that "to those who may have received Deportation Orders since the start of the pandemic but before this review, rest assured that we will continue our pragmatic approach throughout Covid-19".

Covid-19 vaccine

The Minister also urged anyone in the State "regardless of their current status" to come forward to receive a Covid-19 vaccine when it is made available to them.

About 160 undocumented migrants are believed to work in the health service and the Minister gave a commitment in the Seanad that "no information gathered as part of that process will be passed to the immigration authorities".

The Minister was speaking during debate on a Bill introduced by the Civil Engagement group of Independent Senators calling for a moratorium on deportations and deportation orders for the duration of the pandemic.

"I believe the low number of deportations since March reflects the discretionary approach which I am applying on administrative basis is working effectively," she said.

She also stressed that "we will continue the pragmatic compassionate approach shown by the Department of Justice and the Garda National Immigration Bureau since the onset of the pandemic".

The Minister also gave some details of her plan to implement a scheme to provide a "pathway to legal residency, and ultimately to the privilege of citizenship", for up to 17,000 undocumented including 3,000 children.

Ms McEntee said referred to the "huge efforts to regularise the status of undocumented Irish immigrants in other countries, particularly the United States.

"As a country, we have asked for generosity, and have received such generosity, for many years from other countries which welcomed Irish people to their shore.

"I believe it is our moral duty to treat those from elsewhere who seek to make Ireland their home with the same generosity and understanding others have shown to us."

She said the scheme will allow long-term undocumented persons to apply for an immigration permission and " the most straightforward option is to adopt a programme which would apply under the Minister for Justice's executive power.

A similar approach was taken when some 2,200 English language students were allowed to stay under a special scheme.

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No deportations during pandemic unless threat to security, says Martin

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People should not be deported during the Covid-19 crisis unless there is a threat to national security, the Taoiseach has said in the Dáil. Micheál Martin told Social Democrats Wicklow TD Jennifer Whitmore that "deportation is a part of our wider migration management programme but in the context of Covid, we have obligations to the health of people, irrespective of status".

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New research suggests that antipsychotic drugs may protect against COVID-19 risk and severity. TEK IMAGE/SCIENCE PHOTO LIBRARY/Getty Images

Antipsychotic drugs could have a protective effect against COVID-19.

People treated with these drugs may have a lower risk of contracting the new coronavirus.

People using these drugs may be more likely to experience a milder form of COVID-19 if they do get the virus.

Antipsychotic drugs may reduce the activation of genes involved in inflammatory and immunological pathways associated with severe SARS-CoV-2 infections.

A group of researchers - led by scientists from the Mental Health Unit of the Virgen del Rocio University Hospital in Seville, Spain - have found that antipsychotic drugs could have a protective effect against COVID-19.

People treated with these drugs may have a lower risk of contracting the virus or may have milder symptoms if they do get the virus.

Some of the findings appear in the journal Schizophrenia Research.

"These are very interesting findings that reflect a clinical reality where we see few patients with severe COVID-19, despite the presence of various risk factors," says Manuel Canal Rivero, a clinical psychologist and lead author of one of the two papers.

Many researchers have spent the past year studying whether or not individuals with severe mental health conditions might be more likely to contract SARS-CoV-2 and develop severe symptoms from COVID-19.

In the issue of Schizophrenia Bulletin published April 28, 2020, a team from the Centre for Addiction and Mental Health in Toronto, Canada, discussed why they believed people with schizophrenia and related disorders were likely to have a higher risk of contracting SARS-CoV-2.

They pointed to features of the condition, such as experiencing hallucinations and possessing a lower awareness of risk. They added that living in crowded settings, such as congregate housing or prisons, where social distancing is difficult, may increase the risk of contracting SARS-CoV-2.

The team wrote that they believed individuals with schizophrenia and related disorders would be more likely to have poor outcomes from COVID-19. This is because they are more likely to have poor physical health, are disadvantaged socioeconomically, and experience stigma and social isolation. Scientists believe that these factors likely elevate mortality from COVID-19.

People with severe mental illness are more likely to have conditions such as cardiovascular disease, diabetes, and chronic respiratory disease. The researchers also pointed out that people with schizophrenia are more likely to smoke, a habit that several studies have linked to developing a more severe form of COVID-19.

Another recent study published in reported that individuals with schizophrenia are at a significantly increased risk of dying from COVID-19.

In contrast, a South Korean study that appears in found that a mental illness diagnosis has no associations with an increased likelihood of testing positive for COVID-19. The study also concluded that people with a severe mental illness had only a slightly higher risk for severe clinical outcomes from COVID-19.

Therefore, "Previous investigations to assess the prevalence of COVID-19 in [the population with severe mental health conditions] have yielded to inconsistent results," the Seville researchers wrote.

For the new study, which appears in Schizophrenia Research, the research team examined data for a representative Spanish population of 557,576 adults.

Of these, 23,077 (4.1%) tested positive for COVID-19 between February and November 2020. There were 1,953 (8.5%) hospitalizations related to COVID-19 and 254 deaths (1.1%).

Among 698 people with severe mental health conditions who received treatment with long-acting injectable (LAI) antipsychotic treatment, 9 (1.3%) tested positive for COVID-19. Only one member of that group displayed COVID-19 symptoms. None had to go to the hospital, and none died due to COVID-19.
This suggests people treated with these drugs may have a lower risk of acquiring a SARS-CoV-2 infection and may be more likely to have a milder form of the disease if they do get the virus, say the researchers.
"The number of COVID-19 patients is lower than expected among this group of people, and in cases where a proven infection does occur, the evolution is benign and does not reach a life threatening clinical situation," says Canal Rivero. "These data as a whole seem to point to the protective effect of the medication."

The research team also points to an earlier review highlighting antipsychotics as potential treatments for Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome.

The Seville research team also observed that "many of the genes whose expression is altered by COVID-19 are significantly down-regulated by antipsychotic drugs," according to a press release about their work.

To make this finding, the research team investigated the gene expression profile of people with COVID-19 and the gene expression profile of people receiving treatment with antipsychotic drugs.

"In a striking way, we have shown how antipsychotics reduce the activation of genes involved in many of the inflammatory and immunological pathways associated with the severity of Covid-19 infection," says Benedicto Crespo-Facorro, professor at the University of Seville and current director of the Mental Health Unit at the Virgen del Rocío University Hospital, both in Spain.

While Prof. Crespo-Facorro stresses that scientists must do more research, he believes the finding could be significant because it may lead to treating COVID-19 with antipsychotics.
For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here

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COVID-19: Antipsychotics may offer protection

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Antipsychotic drugs could have a protective effect against COVID-19. People treated with these drugs may have a lower risk of contracting the new coronavirus. People using these drugs may be more likely to experience a milder form of COVID-19 if they do get the virus.

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Methadone users 'actively discouraged' from becoming drug free. Published study in the International Journal of Drug policy finds through interviewing users that they feel trapped by the medicine and mention that doctors regularly encourage higher doses. The drug is referred to as 'liquid handcuffs' by one participant. Interesting article on a substance which is meant to be a stepping stone toward sobriety.

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Methadone users who wish to become drug free are being discouraged by doctors, who are often more interested in increasing patients' doses, a new study claims.

Those prescribed methadone to help them stay off heroin describe themselves as "lifers" bound in "liquid handcuffs" which prevents them from becoming drug-free.

According to the study, which was carried out by Trinity College academics and published in the International Journal of Drug Policy, users view methadone as a "ball and chain" and doctors rarely assist in helping patients come off the drug.

"Those who aspired to reducing their daily methadone dose or becoming drug free reported not merely that they were not assisted in striving towards these goals, but that clinicians did not permit them to discuss such an aspiration," authors Paula Mayock and Shane Butler wrote.

The authors conducted in-depth interviews with 25 long-term recipients of Methadone Maintenance Therapy (MMT), 16 of whom had been on methadone for more than 20 years.

Indefinite MMT, along with needle exchanges and other harm reduction initiatives, was introduced in Ireland in the late 1980s to combat the heroin epidemic which had taken hold in urban areas.

There are about 10,000 people on MMT in Ireland, including a large portion who have been taking the drug for many years.

Although recent drug policy documents use language such as "pathways" and "progression" to a drug-free lifestyle, many MMT recipients who took part in the study felt methadone left them "trapped in a cycle that did not lead to progress or change".

'Held hostage'

The majority of participants felt MMT had a positive impact on their lives in at least one respect, including increased stability, the opportunity to rebuild family relationships and less contact with the criminal justice system as they did not have to steal to feed their addiction.

But this was almost always juxtaposed with the feeling that MMT prevented users from moving forward.

One of the participants, identified as Dillon, said MMT stalled but did not fix the problem.

"It's only just keeping it at a certain stage, it's not getting any better, you know what I mean. I just feel like [methadone] is holding everyone."

A woman identified as Yvonne said methadone represents "a ball and chain. Liquid handcuffs we like to call it. To me it represents stagnant, no change".

"Bernie" described being "held hostage by this green substance" which made her feel like the Tin Man from the Wizard of Oz. "Like the Tin Man has to take his oil before he starts his day."

Dose reduction

Most participants entered MMT in the belief they would eventually come off the drug. However, they learned this aspiration was "strongly discouraged".

"Not once have I heard a doctor encourage me to come off methadone. Even when I was wanting to come off I was actually told that I couldn't," said Dillon.

Some participants described asking for a reduction in their daily dose, however requests were refused without a discussion of pros and cons, the authors said.

"Indeed, a large number of participants were critical of what they described as regular offers on the part of their prescribing physicians to have their daily dose increased but with no mention or discussion of a dose reduction."

The authors concluded a new, more realistic policy is "urgently needed" to help MMT users towards an improved quality of life.

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Methadone users 'actively discouraged' from becoming drug-free

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Methadone users who wish to become drug free are being discouraged by doctors, who are often more interested in increasing patients' doses, a new study claims. Those prescribed methadone to help them stay off heroin describe themselves as "lifers" bound in "liquid handcuffs" which prevents them from becoming drug-free.

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‘How two different, expensive healthcare systems on this island have managed to (occasionally) work well together’ https://www.thejournal.ie/all-island-healthcare-shared-island-5385981-Mar2021/

This Journal article examines the difference between the UK’s National Health Service (NHS) and Ireland’s Health Service Executive (HSE); with particular emphasis on the cost of each system.  This piece discusses the programmes and organisations which already exist to encourage collaboration between the two systems in order to maximise positive health outcomes for patients.

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This article is interesting as it is about a co-founded Irish company whose aim is to provide an alternative to IVF. They are trying to democratise access to fertility treatments for couples and individuals. It will be the first of its kind and combats the lack of financial support provided to those in need of IVF treatment. It provides access to everyone and it is a huge step in improving fertility care and its affordability.

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Béa Fertility, an Irish co-founded start-up, is looking to provide an alternative to in vitro fertilisation (IVF) for those struggling to conceive with an at-home fertility treatment that will be offered via a monthly subscription.

The London-based company founded by embryologist David O'Rourke and femtech specialist Tess Cosad, has just raised $1 million (€850,000) in seed capital ahead of its launch later this year.

The founders say they are looking to "democratise" access to affordable, effective fertility treatments for couples and individuals who are struggling to conceive. IVF may be both too expensive for some of these people and can take a huge physical and emotional toll on those involved.

While initially focused on Britain, Mr O'Rourke said the company was interested in making its subscription service available in Ireland as well.

"We are aiming to provide this service locally and we are currently in the process of getting regulatory approval in Europe, " he said.

IntraCervical Insemination

Infertility is estimated to affect one in seven hetersosexual couples in Ireland and Britain. A cycle of IVF locally usually costs between €6,000 and €10,000 in Ireland depending on which treatment is required and which clinic is used. Currently, there is no financial support for those turning to the treatment, other than tax relief. While support is more readily available in Britain, there are strict criteria as to who is eligible for it.

Béa's clinical-standard fertility treatment enable couples to carry out intracervical insemination (ICI) at home. The service, which will cost about £300 (€352) a month, involves placing a small cup of semen close to the cervix for two consecutive days in a month - a strategy called double insemination - and leaving it there for four to 12 hours. During that time, women can go about their days normally.

The start-up says its service improves the chances of conception by 40 per cent if used over three months, and by as much as 60 per cent if used over six months.The subscription service involves ICI devices, ovulation tests, pregnancy tests, and access to an app to help track ovulation dates and the progress of their fertility journey.

'Highly effective'

"The great thing about taking a different approach to treating infertility, as we are doing, is that the treatment comes to the user in their home so if you have a postal address you have access, and we want to provide access to everyone in need," said Mr O'Rourke.

"The situation in Ireland is different when compared to the UK, worse you might even say," the Dubliner said.

Mr O'Rourke said the start-up has gone through over 90 design iterations of its ICI device to reach the right balance of effectiveness and user-friendliness.

The British government-backed Innovate UK is among Béa backers.

The company said it intends to use the financing it has secured to take its product from prototype stage through clinical studies. It hopes to formally launch the subscription service later this year.

"ICI is clinically proven to be highly effective when it comes to increasing the chances of conception, but it's not made available to people at the beginning of their fertility journey. Instead, they have to take a big leap into the expensive world of invasive treatments. But for people where there's no medically identified issue causing infertility, ICI can be the ideal way of maximising their chances of getting pregnant," said Ms Cosad.

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Irish co-founded start-up to 'democratise' fertility treatment with at-home service

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Béa Fertility, an Irish co-founded start-up, is looking to provide an alternative to in vitro fertilisation (IVF) for those struggling to conceive with an at-home fertility treatment that will be offered via a monthly subscription. The London-based company founded by embryologist David O'Rourke and femtech specialist Tess Cosad, has just raised $1 million (€850,000) in seed capital ahead of its launch later this year.

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This article discusses the overcrowding of hospitals are battling to save lives. The article also highlighted how covid-19 cases are decreasing.
Why is this article interesting?
Hospitals across Ireland are facing overcrowding due to the pandemic. The article informed readers on the importance of following government guidelines in relation to covid-19. The article advised readers to stay at home as this will help resolve the issue of overcrowding in hospital. This article is interesting as it is informative provides statistics and highlights the effect the pandemic has on hospital but also has some positivity as it mentions the decrease in covid-19 cases.

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Ireland is beginning to flatten the curve again "through the solidarity shown by families and communities across the country", Chief Medical Officer Dr Tony Holohan said on Saturday night as Nphet announced a further 77 deaths of Covid-19 patients.

The National Public Health Emergency Team (Nphet) also reported 1,910 further cases of the disease, bringing to 186,184 the total recorded cases to date and the total number of deaths in the pandemic to 2,947.

Saturday is the first time the case number figure has dipped below 2,000 since January 1st even though the number of deaths from the disease remains high and hospitals in the Republic remain under severe pressure.

HSE chief Paul Reid tweeted on Sunday morning that it was "battling to hold the levels of care that we value & to save lives". He said 650 Covid-19 patients were receiving some level of critical care, with 214 in ICU and 436 on advanced respiratory support. "It's not an Emergency Dept crisis now but it's probably more critical than that," he added. There were 1,893 people in hospital with coronavirus at 8pm on Saturday.

The head of the Irish Nurses and Midwives Organisation (INMO) has warned that upgraded safety standards are urgently needed in Irish hospitals where Covid-19 infection rates are "out of control" and "directly harming frontline staff",

Phil Ní Sheaghdha, INMO general secretary, has called on the HSE to introduce urgent upgrades to safety measures for hospital staff including a national requirement that high-standard FFP2 masks be used in all healthcare settings, not just basic surgical masks. The INMO said the distance between beds must also be increased from one metre to two and that regular testing for all staff in healthcare settings should be carried out on a rolling basis.

Of the cases notified on Saturday 887 were men and 1,016 were women, 57 per cent were under 45 years of age while the median age was 40 years. A total of 710 were in Dublin, 150 in Cork, 103 in Meath, 102 in Limerick, 86 in Louth, and the remaining 759 cases were spread across all other counties.

Solidarity

Chief Medical Officer Dr Tony Holohan said: "Through the solidarity shown by families and communities across the country in recent weeks, we are beginning to flatten the curve of Covid-19 infection.

"Each individual effort to follow the public health advice is making an impact, but we can only continue this positive trend and drive down incidence in the community by continuing to stay at home and avoid meeting or mixing with others in our social circle, including for any close family gatherings, such as birthdays or funerals, as these can be 'super-spreader' events.

"We know it is possible to have Covid-19 without displaying symptoms, so we all need to behave as though we are infectious and minimise our close contacts with others. If you suspect that you might be ill, isolate away from others in your household, let your close contacts know and come forward for testing as soon as possible."

Earlier, Taoiseach Micheál Martin said Ireland faced Covid-19 restrictions for the first six months of the year and noted a problem with the supply of AstraZeneca vaccine would delay the rollout to the over-70s.

He also said schools would not be fully open to all students before St Patrick's day and confirmed the Cabinet would be considering restrictions to foreign travel when it meets next week.

Mr Martin said while he wasn't necessarily suggesting a six-month lockdown, the Government would be taking a "cautious and conservative approach" with regard to reopening the country, particularly in light of the new variants of the virus.

Nphet has advised that restrictions currently in place should be extended to the end of February, denting hopes of a reopening of the construction sector at the start of next month.

Sources expect that restrictions will be extended until at least the end of Februar but speaking on RTÉ Radio One on Saturday morning, Mr Martin said to relax some restrictions next month, figures for Covid cases must be "well down". He said he was concerned about the UK variant, as it is currently responsible for 62 per cent of cases.

"It transmits more easily. If we have mass mobilisation, and mass socialisation, it will spread again. I think with the vaccines coming, there's a need to be cautious and conservative for the first half of this year until we roll out the vaccines," he said.

"We will be witnessing far more prolonged restrictions than we have to date. I'm the Taoiseach, but I have to consult with my colleagues and Ministers, and we'll consult with the opposition as well, but that is my sense of it until we get control."

He added: "I'm not saying there's a six month lockdown by the way, I'm saying simply we will have a conservative and cautious approach to reopening and we'll be looking at this every four weeks."

Mr Martin said that by the summer, there will be a "changed environment" because of the large-scale vaccination that will have been achieved by then.

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Crowded hospitals 'battling' to save lives but Ireland is starting to flatten the Covid-19 curve through 'solidarity'

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Ireland is beginning to flatten the curve again "through the solidarity shown by families and communities across the country", Chief Medical Officer Dr Tony Holohan said on Saturday night as Nphet announced a further 77 deaths of Covid-19 patients.

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This article discusses how Covid-19 affects the treatment of cancer patients. WHO claims that the pandemic has affected cancer patients massively particularly in terms of diagnosis and treatment.
Why is this article interesting?
In recent months governments have had cancer treatment partly or completely disrupted due to the pandemic. There has been a delay in the diagnosis of patients hindering their treatment. Healthcare professionals are under great stress to provide services due to the restrictions in research the pandemic has caused along with clinical trial enrolment. This article highlights how covid-19 is affecting the publics health and there must be solutions to this issue.

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More than a year since the new coronavirus crisis began, its impact on cancer care has been stark, with "50 per cent of governments (having) cancer services partially or completely disrupted because of the pandemic", said Dr. André Ilbawi, from WHO 's Department of Noncommunicable Diseases.

"Delays in diagnosis are common. Interruptions in therapy or abandonment have increased significantly," he continued, adding that this would likely have an impact in the total number of cancer deaths in coming years.

Pressure to deliver

"Healthcare professionals have been under great stress to deliver services and there are significant reductions in research and clinical trial enrolment. To state it simply, the consequences of the pandemic on cancer control efforts have been profound."

An unspecified number of countries "of all income levels" had been affected, the WHO medic continued, although some wealthier nations had managed to counter the effects of the pandemic, including the Netherlands, where special programmes have been set up to speed up access to cancer diagnosis and treatment for those with symptoms.

Amid uncertainty over which COVID-19 vaccine might be most suitable for cancer patients, given the increased vulnerability of some individuals, Dr Ilbawi said that data from ongoing clinical vaccine trials had yet to be published.

"We do appreciate that cancer patients are being noted in these clinical trials because evidence has shown that cancer patients are at greater risk for COVID-related morbidity and mortality because of their immuno-suppression", he said.

Trillion-dollar issue

According to the WHO, the economic burden of cancer on communities is huge and increasing; in 2010, its cost was estimated at $1.16 trillion.

"In 2020, the number of people diagnosed with cancer globally reached 19.3 million, with the number of people dying increasing to 10 million", said Dr Ilbawi.

According to the agency, there were 2.3 million new breast cancer cases in 2020, representing almost 12 per cent of all cancer cases. It is also the leading cause of cancer death worldwide among women.

Speaking via Zoom in Geneva ahead of World Cancer Day this Thursday, Dr Ilbawi noted that "for the first time, breast cancer now constitutes the most commonly occurring cancer globally, followed by lung, which has historically been leading cause in most of, of cancer, and third colorectal".

Worldwide burden

The WHO official warned that the burden of cancer is expected to rise further in the years ahead for a variety of reasons including population growth, with the number of new cases worldwide in 2040 likely to be 47 per cent higher than in 2020.

The greatest increases will be in low and middle income countries where late-stage diagnosis and lack of access to quality and affordable diagnosis and treatment are common, the UN agency said in a statement.

Highlighting efforts to tackle cervical cancer, WHO noted that it is the fourth most common cancer among women globally, with an estimated 604,000 new cases in 2020 and 700,000 cases and 400,000 deaths forecast in 2030.

Sufferers from poorer countries are disproportionately affected, with nearly 90 per cent of global deaths in 2020 from cervical cancer occurring in low and middle income nations.

Diagnose and treat quickly

Underscoring the benefits of early diagnosis and appropriate treatment, the UN health agency appealed for better availability of human papillomavirus vaccine ( HPV) and low-cost approaches for screening and treating pre-cancer "before it progresses to invasive cancer", in addition to new approaches to surgical training.

"To get on the path to eliminate cervical cancer, we must achieve three targets by 2030: 90 per cent of girls fully vaccinated with the HPV vaccine by 15 years of age, 70 per cent of women screened using a high-performance test by age 35 and again by 45 and 90 per cent of women identified with cervical cancer treated," WHO said.

Achieving these targets would lead to a decline in cases of more than 70 per cent by 2050 and help to avert 4.5 million cervical cancer deaths.

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Impact of COVID-19 on cancer care has been 'profound', warns UN health agency

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The COVID-19 pandemic has had a "profound" impact on the diagnosis and treatment of cancer around the world, the UN World Health Organization (WHO) said on Tuesday, before highlighting that breast cancer has become the most common type of the disease.

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The article discusses people mental health in Ireland and how covid-19 affects mental health. The article states that

"Deaths by suicide did not increase internationally during the first wave of the pandemic"

Why is this article interesting?
This article is interesting as informed the readers that rates of suicide did not increase in wealthy countries during the first pandemic. The article discusses the research carried out. Researchers compared suicide rates from previous years to the rates during the first pandemic. Many people would argue that lockdown has affected people's mental health negatively causing them to resort to suicide, this article argues otherwise. Irelands first professor of mental health states the importance of mental health supports and monitoring trends.

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Deaths by suicide did not increase internationally during the first wave of the pandemic

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Flexible mental health supports, monitoring trends, and countering misinformation are of key importance, Ireland's first professor of public mental health believes.

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This article discusses the major shortage in vaccinations against Covid-19.
Why is this article interesting?
I found this article interesting as it informed readers that Ireland will receive 300,000 less vaccinations in the first three months i the year due to supply issues. This has implications for Ireland as it means the lockdown will potentially be extended.(Prof MacCraith,2021) stated that is confidence in the vaccinations has been dented due to the  AstraZeneca production issues

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Ireland will receive 300,000 fewer doses of Covid-19 vaccines in the first three months of this year due to supply issues with the AstraZeneca jab.

Professor Brian MacCraith told an Oireachtas committee that Ireland now expects 1.1 million doses of vaccines to be delivered by the end of March, rather than the original 1.4 million.

It means that 550,000 people can be vaccinated in that period - about 150,000 fewer than the Government's 700,000 target.

Prof MacCraith added that there is no certainty over the supply of vaccines from April onwards.

"We have a level of confidence for this quarter," he said, adding that that confidence has been dented due to the AstraZeneca production issues.

"The assurances we had received indicated 1.4 million doses across AstraZeneca, Pfizer and Moderna. The simple calculation, given they're all dual doses, leads to 700,000 people being vaccinated.

"However, as we learned in recent days, AZ has indicated a significant drop. So that 1.4 million doses has dropped to just above 1.1 million doses."

Prof MacCraith said he expects the drop in the delivery of the AstraZeneca vaccine to be a 50% reduction in the next two months.

"The totality for quarter one now is 286,000, when we have been planning on expecting 600,000 doses of AstraZeneca," he said.

"So that gives you that approximate 50% reduction."

But he added that those figure may change again depending on the outcome of the negotiations between AstraZeneca and the European Commission, and depending on deliveries of other vaccines.

As of January 27, a total of 161,500 vaccines have been administered to long-term care home residents and staff and frontline healthcare workers.

TDs and senators were told that an average of 48,000 doses of vaccine have been administered per week over the past three weeks.

"We're sticking to the principle of administering vaccines as soon as they arrive," Prof MacCraith said.

"We're right to the edge of the supply that's available. There are no vaccines resting in the fridges or freezers in any given week."

Prof MacCraith and representatives from the HSE appeared before the Health Committee on Friday to provide an update on the rollout of Covid-19 vaccines.

TDs and senators were told that the HSE is working towards providing daily updates on the vaccination rollout, but no fixed date for these was given.

The HSE's lead for the vaccination plan and workforce, David Walsh, said he does not know how many care residents and staff of care homes have yet to be vaccinated.

He told the committee there are 117 nursing homes where "substantial numbers" could not be vaccinated because they were either ill or had been ill within four weeks of the doses being administered.

He also said there are 400 residents and staff of four nursing homes who have not been vaccinated on public health advice due to the severity of Covid-19 outbreaks.

Under the Government's plan, all residents and staff at nursing homes were due to be vaccinated by last Sunday.

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Major blow for Ireland as health bosses confirm massive vaccine shortage

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Ireland will receive 300,000 fewer doses of Covid-19 vaccines in the first three months of this year due to supply issues with the AstraZeneca jab. Professor Brian MacCraith told an Oireachtas committee that Ireland now expects 1.1 million doses of vaccines to be delivered by the end of March, rather than the original 1.4 million.

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Why is this article interesting?
In recent months it has been said that pregnant women should not be vaccinated against Covid-19 due to the high risk factor to the pregnancy. However this article suggests otherwise, over 60,000 babies have been born during the pandemic 6 of which have been still born due to Covid-19 complications. Professor Mckenna believes that if a pregnant women has a high risk of getting the virus she should be vaccinated. This is interesting as not many other countries in the westerns world report similar findings on this topic.

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The director of the Health Service Executive's National Women and Infants Programme has said it is "more important" that pregnant women protect themselves from Covid-19 than the rest of the population, but he does not think all pregnant women should be automatically vaccinated.

Professor Peter McKenna was speaking on RTÉ's Today with Claire Byrne in relation to six stillbirths in Ireland linked to coronavirus-related infection of the placenta - Covid placentitis.

He said the advice to minimise contacts "applies to pregnant women even more than it does to the rest of the population".

Prof McKenna moved to reassure expectant mothers that 60,000 babies have been born in Ireland since the pandemic began of which there were six stillbirths linked to the condition.

He said it is important that if pregnant women "come into contact with Covid" that they inform the hospital looking after their pregnancy so they can be closely monitored.

"The general public health advice, which is to minimise contacts, applies to pregnant women even more than it does the rest of the population. I think that goes without saying.

"Before this information became available our concern was mostly with how Covid affected the pregnant woman. Ireland has done well in general terms in that regard.

"There has been no cases where a pregnant woman has died as a result of Covid. So, the fact that this can affect the baby does change the emphasis, and I think it becomes even more important that pregnant women do not come in contact with Covid and if they do, that their hospital looking after their pregnancy is aware of this, and is able to take steps to follow them up closely."
Latest coronavirus stories
In relation to the vaccination of pregnant women, Prof McKenna said he does not believe the vaccination schedule should change for this cohort.

"The current advice that if you're in a high-risk category, and you're pregnant, say for example you've got heart disease or you've got renal disease, or any other disease that poses a significant risk, the correct advice is that you should be vaccinated because if you do get Covid it poses a very real risk to that mother, never mind to the baby."

Prof McKenna said: "I think that it's a very big step in saying that if you're high risk you should be vaccinated, to going on and saying all pregnant women should be vaccinated.

"The reason I say this is that the condition that I'm talking about - Covid placentitis - the disease has been here for 15 months, and we're only beginning to become aware of this possible complication.

"So it's difficult to see how we can extrapolate that to saying that for all pregnant women the vaccine couldn't possibly have any complications.

"So out of an abundance of caution I would say it's a big step from saying, pregnant women at risk should be vaccinated, to all pregnant women should be vaccinated."

Prof McKenna said it is "strange" that health authorities in the rest of the world have not reported similar findings in relation to coronavirus-related placentitis.

"It is strange that this part of the world, which hasn't suffered hugely from Covid is the one part of the world where this appears to be a bigger issue than it is elsewhere".

Babies have died as a result of Covid-19 elsewhere, but he said, "in the numbers that we're talking about, that hasn't been recognised, outside of Ireland, to the best of my knowledge".

Prof McKenna said it is "noteworthy" that the cases of Covid-19 related placentitis appear to have happened since Christmas, "when we had the enormous surge in numbers".

"It could well be that this was associated with our surge that we had after Christmas when the infection was rampant in the community. That being the case, one would have every expectation that we're going to see it happening a lot less from now on."

Prof McKenna said that the placenta begins to function in taking over the care of the baby from 12 weeks gestation, after the first trimester.

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Vaccinating all pregnant women against Covid 'big step'

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The director of the HSE's National Women and Infants Programme has said it is "more important" that pregnant women protect themselves from Covid-19 than the rest of the population, but he does not think all pregnant women should be automatically vaccinated.

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This article discusses the lack of faith in the fairness of the governments Covid-19 vaccine rollout.
In recent months there has been various different situations where a number of unknown people have been vaccinated ahead of their allotted places in the queue for the vaccines. The article goes on to suggest that that the lack of IT and other controls results is mishaps like this happening continuously. The article shows other figures from different publics health sectors which have vaccinated more people than there are recorded patients and employees. This article is interesting as it highlights the flaws and lack of control on the Covid-19 vaccine rollout in Ireland.

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Fairness, safety and effectiveness are the foundation stones of the Government's Covid-19 vaccine rollout, the biggest project of its type undertaken in the history of the State.

But is that principle of fairness being overlooked in the practical implementation of the plan, to an extent that it is starting to undermine the overall rollout?

The breaches of the principle, which have seen an unknown number of people vaccinated ahead of their allocated places in the queue, seem all the worse given the sluggish supply of vaccines to Ireland, which is lengthening the delays for the vast majority of us who remain unvaccinated.

A series of specific incidents has attracted widespread attention: the vaccination of staff family members at the Coombe hospital; the Beacon Hospital vaccinating staff of a nearby private school; and University Hospital Tralee giving the jab to local builders.

However, a much bigger overall problem seems to be the lack of IT and other controls to ensure that those being vaccinated at present are in the appropriate prioritisation category. The HSE says 220,000 "front-line" healthcare workers have been vaccinated, yet only 80,000 of these work for the State health provider.

Even allowing for the GPs and pharmacists and their support staff, and all the other private-sector, voluntary, section 38 and section 39 health staff with patient-facing roles, it is very difficult to see how these numbers add up. The HSE was asked twice for a breakdown of the numbers vaccinated in these categories for this article, but did not provide one.

Due to the high numbers involved, it has taken three months to fully vaccinate this single cohort.

Some 177,000 people have been vaccinated in long-term residential care facilities. There are 32,000 residents in nursing homes, and about 20,000-30,000 staff. Perhaps the balance of vaccinations can be accounted for by staff and clients in other kinds of congregated settings. But who knows? Again, no breakdown of the numbers is forthcoming.

Meanwhile, HSE office staff in Dublin and Offaly have been vaccinated despite not having contact with patients, it has been reported. Credible reports suggest this practice was not confined to these locations. Many of these staff have been working from home during the pandemic.

Vulnerable people

Merchants Quay Ireland and St Michael's House, both funded by the HSE, say their support staff have been vaccinated, along with workers dealing directly with clients.

While this is happening, large numbers of vulnerable people wait and wait for their vaccine. I have written recently about a 105-year-old great-grandmother in Co Galway, and a 97-year-old bed-bound grandmother in Dublin, who have no idea when they are going to be immunised.

The question of what exactly constitutes a "front-line" health worker was addressed by HSE chief clinical officer Dr Colm Henry in a document distributed across the health service in January.

Sequencing should not be based on where people work, who they work for or the category of worker or grade, Dr Henry advised. Staff in the community have as much right to be immunised as those in hospitals, and private-sector workers enjoy the same priority as those in the State health system.

Sequencing, he said, should be based on "the best practical estimate of exposure risk".

Dr Henry effectively allowed some wriggle room by saying the vaccination programme "has to be practical to administer" and that no doses should be wasted.

He also recommended centres established stand-by lists of other healthcare workers available at short notice should front-line staff not be available.

There are legitimate reasons why some people might be vaccinated ahead of their place in the queue. As Dr Henry advised, it is important no doses are wasted, and it could prove difficult to find people in the right priority category at short notice. An office-based worker might need to occasionally visit patient areas, and so would need to be protected against the virus.

Some would sympathise with a manager who decides to put forward all of the team for immunisation rather than make a potentially divisive call for some staff not to be vaccinated.

Out of sequence

None of these reasons adequately explain the many credible reports, mostly from people inside the system, I have received of people being vaccinated out of sequence.

In the early stages of the vaccine rollout, hospitals were given an allocation of doses and effectively told to "get on with it". The more doses administered, the better the figures looked. A lack of proper computer systems made it difficult to track the details of those receiving a vaccine.

Even now, the portal used for people registering for vaccination is unable to check their credentials, and it is only when they arrive at the vaccination centre that their eligibility can be assessed.

The HSE says the sequencing of cohorts is managed locally, based on the information provided by the person.

"We will do everything in our power to ensure that no vaccine is inappropriately allocated to people attempting to undermine the vaccination programme by seeking a vaccine out of sequence," a spokeswoman said.

The case for some independent oversight of vaccine allocation is growing. Yet the irony is that none of this would matter if the rollout of the vaccine was proceeding faster and there was enough supply to go around the general population.

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Public's loss of faith in fairness of vaccine rollout must be addressed

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Fairness, safety and effectiveness are the foundation stones of the Government's Covid-19 vaccine rollout, the biggest project of its type undertaken in the history of the State. But is that principle of fairness being overlooked in the practical implementation of the plan, to an extent that it is starting to undermine the overall rollout?

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This article discusses the effects of the Covid-19 pandemic on the tourism industry.

Why is this interesting?
I found this article interesting because it explains that the Covid-19 pandemic has had the worst effects on Dublin. the article discusses talks of opening up hotels throughout the country but not in Dublin. There has been simply no end to this pandemic and many countries are still in lockdown like Ireland is causing the tourism industry to decline every day, which will make it very hard for may tourism businesses to reopen when things finally come to an end.

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Summer hotel bookings are slowly beginning to recover in traditional domestic tourism hot spots but Dublin hotels appear to be in line for another disastrous season, according to figures released by the Irish Hotels Federation.

A federation survey of its members shows that 23 per cent of Irish hotel rooms are booked for July with 21 per cent reserved for the following month, in what the federation described as "early signs of an uplift". The traditional tourist magnet areas of the southeast and southwest are at 38 per cent and 35 per cent respectively for July, with both at 33 per cent so far for August.

However, Dublin hotels are just 11 per cent booked so far for July and 12 per cent for August. With domestic holidaymakers fleeing from the city to other parts of the country and the numbers of international tourists who normally fill the capital's hotels expected to be negligible this year, it appears unlikely that the gap between Dublin hotels and the rest will grow.

Other cities are 18 per cent booked for July and 17 per cent for August. Bookings are coming faster for the Border region, which includes secondary tourism areas such as the lakeland regions of Leitrim and Cavan. It is 30 per cent booked for July and 28 per cent for August. The west is at 29 per cent and 22 per cent, the midlands is at 21 per cent and 20 per cent, and the midwest 21 per cent and 18 per cent.

In September after the new school year is due to start, national bookings slide to 18 per cent but rise to 15 per cent in Dublin. The southeast and southwest dip to 26 per cent and 23 per cent respectively.

"There is still a long way to go before hotel occupancy reaches even last summer's levels," said federation chief executive Tim Fenn. "Recovery will be a challenge for the hotel sector this year, requiring continued Government support through to 2022, when the tourism industry should start to recover in earnest."

The survey was carried out on April 6th-8th and the results are based on the response of 330 properties with 32,850 guest rooms spread countrywide.

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'Early signs' of summer hotels recovery but Dublin lags far behind

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Summer hotel bookings are slowly beginning to recover in traditional domestic tourism hot spots but Dublin hotels appear to be in line for another disastrous season, according to figures released by the Irish Hotels Federation.

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Covid and Domestic Violence.
This article raises the problem of Domestic Violence in Ireland. Due to the pandemic, domestic violence has increased. Social isolation, psychological strains and poor coping mechanisms, such as substance abuse, as a result of covid, have all largely contributed to DV.
An Garda Siochana have received 25% more domestic violence calls in April and May 2020, compared to 2019. The worldwide problems with mental health and domestic violence have been lingering, and heightened during the pandemic, its clear there needs to be more accessible services and supports put in place.

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"Domestic violence is a crime, and no one deserves to feel controlled, threatened, be assaulted or to live in fear."

That is the view of consultant psychiatrist Prof Gautam Gulati of the University of Limerick's school of medicine. It is a timely observation, following an investigation he undertook with consultant psychiatrist Prof Brendan D Kelly of Trinity College Dublin into domestic violence during the Covid-19 pandemic, and published in the International Journal of Law and Psychiatry.

Prof Gulati says that Covid-19-related measures seem to be associated with an increased risk of domestic violence: "Social isolation, exposure to financial and psychological stressors, an increase in negative coping mechanisms - such as alcohol or substance misuse - appear to play a part. For victims, an inability to access support mechanisms or escape abusive households, owing to quarantine measures or travel restrictions, heightens vulnerability."

Prof Gulati and Prof Kelly cite evidence showing that since governments around the world restricted travel to prevent the spread of Covid-19, concerns about domestic violence have been expressed in many countries, including China and Italy.

"And in Ireland, " Prof Gulati explains, "there is evidence that An Garda Síochána received 25 per cent more domestic violence-related calls in April/May 2020 compared to a year earlier. Organisations who play a crucial role in supporting victims also reported substantial increases in calls for help. This rise is in keeping with the international picture seen in countries such as France, China, Italy, and the UK."

Global challenge

And the nature of this global challenge is confirmed by research Frontiers | Editorial: New Perspectives on Domestic Violence: From Research to Intervention | Psychology reporting that one in four women in EU member states have been affected by domestic violence, with consequences including "lack of self-esteem, feeling shame and guilt, difficulties in expressing negative feelings, hopelessness and helplessness, which, in turn, lead to difficulties in using good coping strategies, self-management, and mutual support networks".

Prof Gulati and Prof Kelly considered whether mental health services have a specific role to play in addressing increased domestic violence during this pandemic, and they make three main points.

First, although there is an association between mental illness and violence, the vast majority of people with mental illness will never be violent;

If you are suffering domestic violence right now, get out of the situation as best you can

Second, people with severe mental illness are at increased risk of becoming victims of domestic violence;

And third, as the Covid-19 pandemic has evolved, "referral rates to mental health and psychology services decline during lockdowns, despite a likely increase in psychological distress, victimisation and mental illness".

Gulati and Kelly are concerned at the possibility "that many people are not seeking help owing to fears that services are overwhelmed, and that attending face-to-face appointments might put them at risk."

Mental health services

Yet, as Prof Gulati emphasises, mental health services are key to providing continuity of care, especially for marginalised populations such as the homeless; people with severe illness; people with comorbid drug or alcohol use disorders; and the many people with mental illness who live in poverty: "A lack of consistent and assertive follow-up," Prof Gulati argues, "will increase risks of mental illness, physical ill-health - including Covid-19 - and domestic violence, especially among potential victims who may depend on mental health services for safety, advocacy and facilitating the wellbeing of their children. It is therefore vital that parity of esteem is maintained for mental and physical health services over the course of this pandemic."

What practical steps can be taken by victims of domestic violence?

Prof Kelly is clear: "If you are suffering domestic violence right now, get out of the situation as best you can. Do your best to adhere to the public health guidelines and restrictions as you do so, but remember that your personal safety, and that of your children, is an urgent matter, even in a pandemic."

Some countries have developed phone apps allowing victims to seek help and make hotel rooms available for those at risk

Prof Kelly further advises that if necessary, ring your local Garda station or, in an emergency, 999. "You can also ring the Women's Aid National Freephone Helpline on 1800 341 900," he says, adding that the helpline is open 24 hours a day, seven days a week: "If you feel you cannot do these things, reach out to someone with whom you can talk: a family member, a friend or someone else. Remember, the Covid-19 pandemic and the public health restrictions do not mean that anyone has to stay in a situation of domestic violence."

Phone apps

Offering a broader perspective, Prof Gulati notes that some countries in Europe have developed phone applications allowing victims to seek help and make empty hotel rooms available for those at risk. Addressing domestic violence, explains Prof Gulati, requires a careful combination of legal measures - arresting perpetrators, barring orders, safety orders; societal responses - bystander responses, advocacy services, shelters; and heightened awareness in frontline community services like medical services, where victims can present with physical or psychological trauma, sexually-transmitted infections, neglect or other sequelae of abuse. "There are key roles," he says, "for mental health services in the identification and management of certain risk factors like substance misuse and providing support, advocacy and treatment services to victims.

"It is crucial that both mental health services and the charities sector, which supports victims, are supported by governmental policy and adequate resourcing through the pandemic."

Supporting charities

And Prof Gulati and Prof Kelly further underline the importance of supporting charities such as Women's Aid "who provide an indispensable service and are often the first point of contact for victims".

In 1993 the World Conference on Human Rights asserted that violence against women is a human rights concern, affecting their fundamental human dignity. Delegates' demands included the elimination of sexual harassment and the eradication of conflicts between the rights of women and the harmful effects of "certain traditional practices, cultural prejudice and religious extremism".

Almost three decades later, the work of Profs Gulati and Kelly reminds us of the continuing importance of that message.
Read: 'It's the kids we don't know about. That is the worry'

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Living in fear: domestic violence during the Covid-19 pandemic

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"Domestic violence is a crime, and no one deserves to feel controlled, threatened, be assaulted or to live in fear." That is the view of consultant psychiatrist Prof Gautam Gulati of the University of Limerick's school of medicine.

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This is an interesting article because it shows how other teachers in St. Gerards in Bray feel about a small minority of teachers receiving the leftover vaccines when they shouldn't have. Although this scandal shows a breach of trust and privilege, I think that it is interesting that the Minister for Health wanted to suspend the Beacon's vaccination programme because I do not believe that the rate of our vaccine rollout in this country puts us in a position to do so.

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A teacher from St Gerard's senior school in Bray has said they are "utterly devastated and very angry" that colleagues received vaccines from the Beacon Hospital.

In a letter to RTÉ's Liveline programme, the teacher wrote that not all teachers at the school had received the vaccine and only a small minority had.

Last week, it was discovered that the privately-owned hospital administered 20 leftover jabs to a number of teachers at the school.

A spokesman for the hospital said that a "small number of leftover vaccines" were administered "in keeping with the zero-wastage policy".

On Friday morning, the hospital released a statement explaining its decision and apologising for the anger caused.

Since the revelation first appeared in the Irish Daily Mail, Minister for Health Stephen Donnelly has asked the HSE to suspend the vaccination programme at the hospital.

On Liveline, Joe Duffy read out a letter from an anonymous teacher in the school who spoke out on the Beacon Hospital controversy.

The teacher said that they are "utterly devastated and very angry by what has taken place."

The statement said: "I just want to make the point that this is not all the teachers in St Gerard's, it is a very small minority of them and they have to live with this. The vast majority had no part in this and yet are being tarred with the one brush.

"The number of teachers and management who took this vaccine is 20. There are approximately 100 members of staff between the two schools. So approximately a fifth are involved in this affair. The chosen colleagues never told or shared this information with the rest of us."

This anonymous employee states that the rest of the teaching staff only learned of this "applying affair" on Friday and that they "should not be expected to carry the can for them."

The letter continued: "The rest of the teaching body and staff only learned of this appalling affair from the breaking news on Friday morning. Teachers and their extended family and staff innocent of this scandal have had to endure text messages and phone calls all weekend asking them if they had skipped the queue and taken the vaccine. We should not be expected to carry the can for them.

"I do not accept these vaccines were going to waste etc, and I can swear I would not have taken the vaccine had I been offered it. I am fit and healthy and am frustrated that my own elderly relatives have not yet been vaccinated, I am glad I did not get the call anyway as I would have then been left knowing that this was going on and then I too would have been complicit.

"It is a disgrace. It should not have happened."

Yesterday, a spokesperson for the Taoiseach said: "What happened was wrong and a breach of trust. Behaviour of this sort undermines confidence in the vaccination programme. The CEO should be held accountable for his actions by the board of The Beacon Hospital."

Elsewhere, Health Service Executive CEO Paul Reid has said that the Beacon's breach of trust and privilege was a "real body blow" to everyone and has caused a lot of anger and fury from the public and "ourselves in the HSE".
For the latest news and breaking news visit dublinlive.ie/news. Get all the big headlines, pictures, analysis, opinion and video on the stories that matter to you. Follow us on Twitter @DublinLive - the official Dublin Live Twitter account - real news in real time. We're also on Facebook/dublinlive - your must-see news, features, videos and pictures throughout the day from the capital.

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St Gerard's teacher breaks silence after Beacon vaccine backlash

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A teacher from St Gerard's senior school in Bray has said they are "utterly devastated and very angry" that colleagues received vaccines from the Beacon Hospital. In a letter to RTÉ's Liveline programme, the teacher wrote that not all teachers at the school had received the vaccine and only a small minority had.

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week 2- Sam Lacey     10% of the Irish have received first jab 

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week 2- Sam Lacey     10% of the Irish have received first jab 

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This news article is about the 'milestone' Ireland has hit in relation to the first dose of a Covid jab in March 2021.
A total of 478,725 have received 1 of the 3 vaccines that are currently being used in Ireland, Pfizer-BioNTech, Moderna and AstraZenceca. The focus on the vaccine distribution is on people over 70, and poeple between the ages of 16 to 65 that may have an underlying health condition, meaning they are of higher risk of Covid 19.

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10% of people in Ireland have now received their first dose of a Covid-19 vaccine

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Over 478,000 people have been administered a first dose.

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why is this article interesting?
This article highlights how Covid-19 affects those who are physically inactive.
Why is this article interesting?
I found this article interesting as it explains that those who are physically inactive are twice as likely to be admitted to hospital.  The article goes on further to discuss statistics surrounding physical health and hospital admissions. It highlights the impact of lack of physical exercise and health. This article is interesting as it informs the public the importance of physical exercise and how it could safe your life.

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People with poor levels of physical activity are far more likely to suffer worse effects from Covid-19, new research has found.

The US-based study, published by the British Journal of Sports Medicine, found "consistently physically inactive" patients were more than twice as likely to be admitted to hospital as those who did 150 or more minutes of physical activity per week.

They were also 73 per cent more likely to require intensive care, and 2.5 times more likely to die of the infection.

"It is notable that being consistently inactive was a stronger risk factor for severe Covid-19 outcomes than any of the underlying medical conditions and risk factors identified by the CDC (The Centers for Disease Control) except for age and a history of organ transplant," the researchers noted.

Physical inactivity has not been included among several risk factors for severe infection such as older age and certain underlying medical conditions including diabetes, obesity and cardiovascular disease.

Impact

In assessing its impact, the researchers compared Covid-19 outcomes in 48,440 adults diagnosed between January and October, 2020.

Around half had no underlying conditions; nearly one in five (18 per cent) had only one; and almost a third (32 per cent) had two or more.

All patients had previously reported their levels of physical exercise. About 7 per cent were consistently meeting the health guidelines, 15 per cent were "consistently inactive", and the remainder reporting some activity.

Of all of them, 9 per cent were admitted to hospital, with 3 per cent requiring intensive care, while 2 per cent died.

"Consistently meeting physical activity guidelines was strongly associated with a reduced risk of these outcomes," the study found.

The research was observational in approach, unable to establish cause, and notably relied on the patients' own assessment of their activity.

However, the authors still concluded that physical inactivity was the "strongest risk factor across all outcomes, compared with ... smoking, obesity, diabetes, hypertension (high blood pressure), cardiovascular disease and cancer."

Trial

Meanwhile, a separate clinical trial whose results have also been published by the British Journal of Sports Science, found that the wearing of facemasks inhibited exercise.

Those who wore them reported increasing shortness of breath and claustrophobia at higher exercise intensities.

Recommendations for wearing masks during exercise vary globally and the physiological impact is poorly understood, the researchers said.

They compared the exercise performance of 31 healthy adults, aged between 18 and 29, while they ran on a treadmill to exhaustion, once wearing a cloth facemask and once not.

Resulting data showed that wearing a mask led to a significant reduction in exercise time and increased shortness of breath.

If found the majority of participants (30) agreed or strongly agreed that it was harder to give maximum effort during the trial while wearing a mask.

The researchers recommended that anyone wearing a mask while exercising should modify the intensity, time and type of activity undertaken.

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Physically inactive people more likely to suffer worse effects from Covid-19 - study

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People with poor levels of physical activity are far more likely to suffer worse effects from Covid-19, new research has found. The US-based study, published by the British Journal of Sports Medicine, found "consistently physically inactive" patients were more than twice as likely to be admitted to hospital as those who did 150 or more minutes of physical activity per week.

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Week 4- Sam Lacey                       

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Week 4- Sam Lacey                       

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Covid and Mental Health.
Ireland has had an exponential increase in people dealing with mental health issues. The Dail have said that there has been a 490% increase in the use of their online mental health platform.
The Minister of Mental Health, Mary Butler has stated that she can see a huge increase in people developing eating disorders and psychosis during the pandemic, as Covid-19 has limited the services and options for people to seek help. A TD in Dublin Mark Ward has said that Ireland as a first world country has a third world mental health system and told the government to put their money where their mouth is.
Mental health services have been a problem for many years, it shouldn't of taken a global pandemic to unravel this hidden epidemic.

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IRELAND is in the grips of a "hidden epidemic" of mental health issues being caused by the Covid-19 crisis with children as young as 16 taking their own life, the Dail has heard.

The Dail heard that the HSE's mental health website has seen an increase in hits by more than 490 per cent over the past year with one in six people in Ireland visiting the online support.

TDs told how GPs are seeing a 30 per cent increase in the prescription of mental health drugs due to "situational depression" caused by the Covid-19 crisis.

Mental Health Minister Mary Butler also revealed that there has been a significant increase in people presenting to the health service with first episode psychosis and eating disorders during the pandemic.

Deputies from across the country today told the Dail of shocking experiences people have had with Ireland's mental health services during the pandemic.

'MENTAL HEALTH BREAKDOWN'

Sinn Fein's Paul Donnelly told how a young man who had suffered a mental breakdown was discharged from A&E in Connolly Hospital after three days because there was no mental health beds available in the country.

He said: "I was contacted by a mother who was upset and distraught about her son. He had a mental health breakdown and the emergency services were called, the gardai were called on eventually the armed support unit was called to deal with the situation.

"He was brought to Connolly Hospital where he was told he would be admitted. Unfortunately the unit in there was locked down because of Covid.

"He was then told he would get another service somewhere else. He waited all day and it didn't materialise. He was in the A&E department for three solid days before they told him that this was not an appropriate place for him to be which is correct.

"Unfortunately there wasn't a single bed available in the entire State. He was told to go home and his mother asked what will happen if another episode happens because he is still in a distressed State and they were told to call the gardai. That is completely unacceptable."

'DARK PLACE'

Fianna Fail TD for Cavan Monaghan Niamh Smyth said she has seen a disproportionate increase in the number of young people taking their own lives or attempting to take their own lives.

She said: "I cannot reiterate the need and the dark place I have seen young people in and the number of lives that have been taken.

"I've seen as young as 16 taken their own life in the constituency of Cavan Monaghan and I don't need to tell you the trauma that is left behind and the trail of destruction for family members and communities.

"In these times it has been particularly difficult to support families in the way that is needed."

Deputy's Smyth's party colleague Marc Mac Sharry told the Dail that 17 per cent of current admissions to the National Rehabilitation Hospital in Dublin are due to attempted suicide compared to just one per cent last year.

'HIDDEN EPIDEMIC'

Longford Westmeath TD Joe O'Flaherty told the Dail about a young man in his constituency who has spent 110 days in complete isolation at St Loman's Hospital due to his mental health condition.

Sinn Fein's David Cullinane said that representatives from the Psychological Society of Ireland have told him the Covid-19 crisis is causing a "hidden epidemic" of mental health.

He said: "They've told me that loneliness, isolation, anxiety, stress and the economic impacts of the pandemic are causing another hidden epidemic in mental health."

Sinn Fein are urging the Government to use capacity in private hospitals and mental health facilities to increase the availability of beds and services for people in need.

'ABSOLUTE SCANDAL'

Dublin TD Mark Ward claimed Ireand is first world country with a third world mental health system and called on the Government to put "money where their mouth is" and increase spending on services.

He said: "Funding for mental health as a percentage of the over all health budget has fallen from 16 per cent during the 1980s to six per cent in 2019 and was 5.2 per cent last year and it has falling further again this year.

"During a national emergency it is an absolute scandal that the percentage allocated to mental health spending has fell.

"Slaintecare recommends 10 per cent of the health budget should go to mental health services but international best practice recommends up to 16 per cent."

Independent TD Micheal McNamara slammed the National Public Health Emergency Team's lack of consideration of mental health issues when they are giving Covid19 advice on restriction to Government.

Mental Health Minister Mary Butler said there have been significant staff issues caused by Covid19 which have put serious strain on services.

She also paid tribute to the 28 residents of mental health servcies in Ireland who have died due to Covid-19.

Minister Butler said she has secured additional funding for early intervention psychosis and eating disorders along with funding to hire more staff.

She also said that there is seven day tele health services available at YourMentalHealth.ie along with a 24/7 phoneline at 1800 111 888 and a text line at 50808.

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Covid-19 crisis causing 'hidden epidemic' of mental health issues in Ireland

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IRELAND is in the grips of a "hidden epidemic" of mental health issues being caused by the Covid-19 crisis with children as young as 16 taking their own life, the Dail has heard.

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This article is about how the significant increase in healthcare funding by Government will provide a 'once-in-a-generation' opportunity to change how healthcare is delivered in Ireland.
Why is the article interesting?
It is interesting because this increased funding means that the HSE will have the
financial means to implement the Sláintecare health reform programme.  The shift in the provision of care from acute hospital settings to community and homecare settings is something the HSE has been planning for years but it has taken a global pandemic to set the wheels in motion.

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Unprecedented funding allocated this year by Government will provide a once-in-a-generation opportunity to change how healthcare is delivered in Ireland, according to the Health Service Executive.

An additional €3.5 billion is to be set aside for the health service for 2021, a 21 per cent increase on the amount provided originally to the HSE for last year prior to the Covid-19 pandemic. Overall, the organisation is to receive €20.6 billion this year.

It said on Wednesday that the new service plan for 2021 will mean 1,146 additional acute hospital beds provided by the end of the year as well as 66 more critical care beds, bringing the total for adults to 321.

The HSE said the new plan provided for additional spending to improve many services including those in the areas of cancer, maternity and mental health.

It said it would allow for an addition of 16,000 staff above the number employed at the end of 2019 including more than 1,100 medical and dental staff, in excess of 3,500 nurses and midwives and 4,000 health and social care professionals.

HSE chairman Ciarán Devane said the organisation now, for the first time, had "the financial means to bring the [Sláintecare health reform] plans to life".

Within the additional allocation of €3.5 billion, some €1.68 billion is being earmarked for spending on Covid-19 requirements while €1.8 billion will go on non-Covid areas.

" [A total of] €1.1 billion of this additional investment is to deliver permanent and enduring improvements in healthcare arising from the Sláintecare reform programme. The remaining €0.7 billion of this underlying [ie non-Covid] increase is to cover the increased costs of providing existing levels of service which have increased due to demographic changes and various cost increases."

The plan states that this year the HSE will "commence, at scale, the implementation of service reform that have been planned for many years. This will involve a demonstrable shift in the provision of care from hospital to community settings . . . to improve access across the board and expanding services that support people to remain at home."

The plan says services in the community will be strengthened. It says five million additional home-support hours and an additional 1,250 rehabilitation and transitional care beds will be provided. It says 22,500 people will be supported through the Fair Deal nursing home scheme.

The plan also sets out that there will be 28 additional beds provided to enable acute mental health services to respond to Covid-19 and increasing demand.

'Drug companies paid €2.4bn'

The plan also emphasises that whole-system reform will be critical.

It says challenges facing the system include waiting lists for scheduled care in hospital and long waits in emergency departments, particularly for older people and those who have more complex needs.

"There are also difficulties for hospitals that are running with very high occupancy levels . . . waiting times for mental health services for children and adults and long waits for community-based services such as therapies also pose challenges. There is not enough home-based support and a lack of person-centred and responsive support for people with disabilities and their families."

The service plan reveals that the cost of the current deal to access capacity in private hospitals during the current surge in Covid-19 cases is costing €47 million per month.

It also says that the HSE will have "limited capacity" within its plan to respond in 2021 to further pay or other pressures, beyond those which have already been provided for.

"In the event that additional unfunded pressures emerge, for example, via the industrial relations machinery of the State, regulatory processes, Government decisions or the courts etc, the HSE will engage with the Department of Health as to how to proceed."

It says the HSE's capacity to respond to new drugs and new indications for existing drugs is "finite" in that it has a budget in this area of €50 million for the year. The organisation says that needs "to be looked at in the context of the circa €2.4 billion the HSE is already paying each year to drug companies".

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HSE flags golden opportunity to change how healthcare delivered

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Unprecedented funding allocated this year by Government will provide a once-in-a-generation opportunity to change how healthcare is delivered in Ireland, according to the Health Service Executive. An additional €3.5 billion is to be set aside for the health service for 2021, a 21 per cent increase on the amount provided originally to the HSE for last year prior to the Covid-19 pandemic.

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This article examines how councils across England are experiencing a funding crisis and in order to assist them with funding are quietly increasing increasing care bills for adults with a disability/mental illness which will force many to severely curtail and restrict their activities/habits. Some people are considering legal options to challenge these measures as it will push many people/families to the edge.

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Adults with a disability or mental illness are receiving extra care bills running into thousands of pounds that they say could force them to cut back on food and heating and threaten their social independence.

Amid a care funding crisis, some English councils are quietly increasing charges to people with learning disabilities and mental illness, in effect clawing back welfare payments and leaving some working-age adults with little more than £3 a day to spend.

People facing the charges fear they will be unable to afford enough clothes and worry that basic pleasures like swimming trips will have to stop. One single man living with bipolar disorder said he may have to put down his dog because he will be unable to afford to look after it.

Care charities have drawn up dossiers of charges they describe as a new "care tax" and say it is a result of national underfunding of social care. The Health Foundation has estimated that at least an additional £6bn a year is needed to meet growing demand, rising to £14bn if the country wants to improve access to care and pay more to staff, many of whom earn minimum wage.

Mencap, the learning disability charity, said it had received dozens of "concerning" calls to its helpline about the issue, and its chief executive, Edel Harris, said it was "causing huge distress for them and their families, ​and leaving many without enough money to cover their additional needs".

Some people are refusing to pay and are considering legal challenges. Care Act guidance says charges must be "reasonably practicable" for people to pay and that the approach to charging should promote "independence, choice and control".

One of the councils levying increased charges, West Sussex county council, said that while it had previously charged working-age care recipients less than Whitehall rules allowed, increases were now necessary because of "decreased funding from central government".

Care recipients in the county have seen weekly charges rise sharply, in one case from £5.59 to £83 a week, and in another from £40 to £151 a month. Matthew Welch, 22, who has cerebral palsy, has seen his care contribution more than double to £77, leaving him with just £23 a week from his welfare benefit, a move his mother, Sarah Welch, described as "appalling".

Sue Livett, the managing director of the Aldingbourne Trust, a charity in West Sussex that provides care for people with learning disabilities and autism, said at least 50 families had complained about increased charges.

A council spokesperson said: "Our charging arrangements follow national guidance and are based on an individual assessment of a person's financial circumstances. We have asked people to contact us if they will find it difficult to pay so we can work with them on an individual basis."

A parent in Staffordshire said their family had been hit with a backdated bill exceeding £20,000 for their adult children with learning disabilities.

"It's disgraceful," they said, requesting anonymity. "They have no opportunity to go out and earn money on their own. They rely completely on benefits."

Also in Staffordshire, a young adult with complex learning difficulties who needs round-the-clock care was sent a bill demanding he pay £88 a week towards the costs, equivalent to £4,500 a year. It has to be taken from his universal credit payments and leaves him with just £25 a week for other expenses.

His mother, a hairdresser unable to work during the pandemic, said she was "absolutely furious" and it meant they would not be able to afford enough clothes for her son, which is a particular issue owing to his incontinence, plus it could prevent him from going to the cinema or the swimming pool with his carers.

"It's a huge effect on his quality of life," she said. "He won't have any variety in his day. We are not acknowledging that people are individuals and have needs in their lives."

Dr Richard Harling, the director of health and care at Staffordshire county council, said the amount people were asked to contribute was "based on what they can afford to pay while still being left with income to meet their living costs".

He added: "If a person feels they are contributing too much, they can contact us to appeal their financial assessment."

Social Care Futures, a coalition of care givers and receivers, has received more than 150 reports of rising charges. "Escalating charges must be capped and there must urgently be a significant investment in social care, our lives and freedom," said Anna Severwright, the coalition's convener.

The Department of Health and Social Care has been contacted for comment.

'It's heartless and cruel'

David Jones and his dog, Meghan, on the beach in Littlehampton, West Sussex. Photograph: Sarah Lee/The Guardian

David Jones, 60, lives alone in West Sussex with bipolar disorder, which 10 years ago rendered him unable to work.

The former newspaper subeditor relies on two hours of support a week to help him keep his flat in order but is facing an increase in his contribution for this from £40 to £151 a month. The money would have to come from his personal independence payment (Pip) and would take up a third of that budget. He said that would leave him choosing between "heating and eating" and it would affect his budget so much that he will have to consider putting down his 14-year-old dog, Megan, which he said would be "beyond awful".

Pip is supposed to help people with illness, disabilities and mental health conditions maintain norms of everyday life. He said clawing this money back was "just ridiculous".

"I simply can't afford it," Jones said. "This extortionate demand represents 20% of my monthly income from benefits. It has to be outright unfair and a national scandal that the Department for Work and Pensions awards us Pip with one hand, and the county council takes up to a third of it away with the other.

"I would have to cut my food budget drastically and might end up having to go to a food bank," he said. "I have a dog and if I was going to try and budget for the amount of money [I have left] the dog would have to go."

He said Megan had been a "lifeline to sanity" during the pandemic and had been "incredibly helpful for my mental health".

"This [demand] has caused me incredible distress and anxiety," he said. "There are people in an even more vulnerable position than me suffering with mental health illnesses, autism and learning disabilities and it must be extremely difficult for them to cope with this. It's really heartless and cruel. I don't think it's going to raise an awful lot for the county council but it's a vast amount for us."

The council has said central government cuts precipitated the increased charges and it has asked "people to contact us if they will find it difficult to pay".

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English councils handing huge extra care bills to disabled and mentally ill adults

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Adults with a disability or mental illness are receiving extra care bills running into thousands of pounds that they say could force them to cut back on food and heating and threaten their social independence.

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This article is about how health services for the LGBTQ+ community in Ireland have been impacted by the pandemic. It describes not only barriers that have been created to accessing sexual health care, but also discusses difficulties patients have faced since before the pandemic in accessing health care. The article is important in that it highlights stigma that still exists, particularly around HIV, and how this prevents these patients accessing the same standard of health care. It points to discrimination in health services, lack of equity, safety, and patient-centredness, and potential risks, as many patients with HIV are currently going untreated as a result of lockdown.

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The closure of the Gay Men's Health Service (GMHS) split a chasm between the LGBTQ+ community and accessible sexual healthcare in Ireland. From March 2020 onwards, activists, artists, researchers, organisations, and so many more have voiced their deep concerns about the consequences of the HSE neglecting these vital services.
Defining An Essential Service
Speaking on the way spaces such as the GMHS are vital in breaking down barriers within the healthcare system in Ireland, researcher at NUI Galway's Health Promotion Research Centre, Dr Elena Vaughan, shared, "There is a fair body of evidence to suggest that gay and bisexual men, and the LGBT community more broadly, experience health inequalities. At least part of the reason for this is due to barriers in accessing healthcare because of stigma - whether perceived or enacted. Services targeted at gay and bisexual men - who in Ireland are disproportionately affected by STIs and HIV - are vital in helping overcome this barrier and reducing health inequalities."

Dr Vaughan has explored a myriad of research topics regarding health related stigma and living with HIV in Ireland. Considering ways for sexual health services to become accessible for the queer community, she expressed, "I think one simple step would be if services were to implement communication strategies to provide relevant information for the community; this would plug an information gap by more effectively communicating about LGBTI+ sexual health, signal that they are inclusive spaces and foster trust among service users. Providing clear non-judgmental information is an important facet of a rights-based approach to sexual health care, which is considered best practice internationally."

Lots of focus on HIV right now with the buzz of #ItsASin. It's important to note, that while things have improved on the biomedical front for PLHIV, stigma remains a problem, including in healthcare. My paper on this is available to read on @ResearchGate: https://t.co/xCYmNuXNKw

- Elena Vaughan (@StigmaStudyIE) February 26, 2021

"I also think it's important generally that services are designed around the needs of their users. This includes looking at practical things such as opening hours and facilitating training to staff to provide appropriate information and person-centred care," Dr Vaughan continued.

Between 1992 and 2020, over 120,000 of the GBT+ community attended GMHS, reflecting the ever growing demand for accessible sexual healthcare services in Ireland. According to the GMHS Annual Report 2019, "1176 men attended GMHS for the first time and a significant percentage had never tested previously for HIV (29%) or other STIs (37%) proving that the continuation of and increased access to the GMHS STI checkpoint is vital."

However, since March 2020, GMHS has remained closed as staff were repeatedly redeployed to assist in COVID-19 testing centres. While most STI clinics resumed services at the end of last year, the LGBTQ+ community are left waiting for the return of these urgently needed services.

Regarding the current state of sexual health services in Ireland, Dr Vaughan addressed the impact of GMHS' continuous closure, "Sexual health services in general in Ireland are over-subscribed and often tricky to access for the populations that need them the most (due to limited places and inconvenient opening hours for example). Having this service closed for the better part of a year means even more reduced access to essential sexual health and STI screening services."

"Having services such as the GMHS open and operating as normal is really essential to making sure the people that need it most can access timely services and get linked in with care if necessary," Dr Vaughan concluded.

Alarming when sexual health services have been severely curtailed

Gay Men's Health Service has been closed for a year

-no provision asymptomatic or symptomatic screening

-no recruitment of any new PrEP patients

-no provision of PEP for those who've had exposure#OpenGMHSnow https://t.co/7JAuKtrVhb

- John Gilmore (@GilmoreJNurse) March 18, 2021

Accessibility In Progress
With the continued closure of the GMHS, demand for GBTMSM specific sexual health services has not disappeared. In January 2021, the HSE reportedly suspended a pilot scheme providing at-home STI testing services due to the overwhelming volume of applicants, with one provider commenting on the "unprecedented interest in the service, with thousands of orders" only a few hours after launching.

Despite this demand being titled as 'unprecedented', activists and healthcare professionals have expressed that it's expected, especially due to the lack of consideration for sex and sexual health in Government responses to the pandemic. As stated in Man2Man's risk reduction guidelines, "Sex is a vital part of our lives and recognised as an important part of maintaining mental and physical health. Stopping or adjusting your regular sexual patterns may be challenging and problematic. The following guidelines have been created to help you to make changes to reduce your risk of getting COVID-19."

Although data from the Health Protection Surveillance Centre (HPSC) shows a 25.5% drop in all STIs and HIV infections falling by 15.5% in 2020, many contested these findings as portraying an inaccurate picture of sexual health in Ireland based on the pandemic affecting testing services. Testing services such as GMHS are vital tools for a person to know their status and help stop transmissions.

UCD Assistant Professor of Nursing and ICU nurse John Gilmore-Kavanagh states, "Home testing is not a replacement for full sexual health services, it's an addition and a really welcome addition but it's not suitable for everyone. And it doesn't provide other areas of sexual health services, such as psychological, emotional, interventions and health promotion aspects."

Regarding access to testing and sexual health care, many LGBTQ+ people do not feel comfortable disclosing their sexuality or gender identity to GPs and as such a safe space like GMHS can alleviate these worries. According to Recognising LGB Sexual Identities in Health Services The Experiences of Lesbian, Gay and Bisexual People with Health Services in North West Ireland, "Deciding whether to tell practitioners about their LGB sexual orientation emerged as a major concern for most research participants in their interactions with health services. Indeed, it was central to all other themes arising in the study and was found to have consequences for the ensuing health care of LGB clients."

The GMHS has been closed for a year now. Other sexual health clinics are open. Why is Ireland's only sexual health clinic for gay & bi men & trans folks still closed?

Take action: go to https://t.co/Xlns3GivQX

Let the HSE know it's been long enough-
it's time to #OpenGMHSNow pic.twitter.com/4ajgWwcm3E

- ACT UP Dublin (@ActUpDublin) March 16, 2021

Speaking on the benefits of specialised healthcare in overcoming these barriers, Gilmore-Kavanagh shared, "Previous experiences of homophobia in healthcare can really prevent people from accessing health services in the future. But having a service that is what it says on the tin, where you can access culturally competent care, is really important. The Gay Men's Health Service is an essential health service. It's also a really important touchstone for general healthcare services."

While speaking about the GMHS closure, Gilmore-Kavanagh comments on how delaying its reopening signify a larger problem regarding current healthcare systems, "I think that's a wider issue around sexual health services in Ireland and the prioritisation of sexual health. My view, as an academic working in healthcare practitioner education and research, sexual health is an essential part of somebody's holistic health and it's pretty important that people have access to that. [...] Sexual health services aren't just, or any health services, about provision and intervention, it's about building therapeutic relationships to provide support for people."

Before the closure of GMHS, the clinic found a new home in the Meath Primary Care Campus, where it began expanding its services to meet different public health issues. Looking ahead, Gilmore-Kavanagh acknowledges that a full reopening must be accompanied by the continuation of these expansions, "What we need to do now is not only open the GMHS to the level at which it was pre-pandemic but looking at how that's going to expand to meet the needs of gay/bi men and the trans community to provide them with holistic sexual health care."

"Ireland has some of the best healthcare practitioners in the world, having worked abroad and within a national context, so committed, and empathetic, and person-centred doctors and nurses and therapists working in Ireland. Almost all of the issues relating to healthcare in Ireland have to do with access, this is no different, we really need to think about that and think about how we can expand access to this really wonderful healthcare," Gilmore-Kavanagh concluded.

A third video from Act Up member Michael O'Dea, this time exploring why LGBT-specific healthcare services like the GMHS are crucial in ending the HIV pandemic #OpenGMHSNow pic.twitter.com/6t8bJrrc7C

- ACT UP Dublin (@ActUpDublin) February 9, 2021

Rallying Behind The GMHS
Amid mounting pressure to reopen the GMHS, ACT UP Dublin campaigned for the service's restoration throughout the past year. Members Orla Keaveney, Pradeep Mahadeshwar, Andrew Leavitt, and Michael O'Dea are spearheading an online campaign #OpenGMHSNow in which they mark each day of its absence by highlighting the urgency in reinstating "safe, judgement-free, and culturally appropriate sexual healthcare."

Speaking about creating a visual identity for the #OpenGMHSNow campaign, designer Mahadeshwar shared, "I created the visual according to what ACT UP is. ACT UP is a passionate place, they like to talk loud and bold. They talk openly about sex and sexual health and that is really important for a community to have these conversations around HIV, PrEP, and around STIs, and testing."

"I put everything visually in such a way that it will give a nice dark, retro feel. [...] As a designer and an activist myself, and as a queer person living in Ireland for eight years, I think talking about LGBTQ+ issues is not only about rainbows and glitter and Pride month. It is a 365-day process we live in, we come across different problems and issues every day," Mahadeshwar concluded.

The Gay Men's Health Service (GMHS) remains closed, leaving Gay, Bi men and the Trans community without a specialised space to address their sexual health needs #OpenGMHSNow pic.twitter.com/H3uhtynXSD

- ACT UP Dublin (@ActUpDublin) February 6, 2021

Illustrating what the GMHS means for him, Mahadeshwar said, "When you are a travelling immigrant as a gay person, you come across different situations and putting yourself in healthcare vulnerabilities is the last thing that you want to happen to you. I keep myself always aware about wherever I will live, what kind of sexual health I can access easily. The GMHS is one of those platforms that say the staff are always good, they communicate with you well and don't make you feel awkward."

As a sign to show the importance of these services, ACT UP Dublin are appealing for the LGBTQ+ community to contact the Chief Officer of HSE Community Healthcare East, Martina Queally about the continued closure of the GMHS, and demand that the clinic be reopened. On Twitter, they wrote, "The GMHS has been closed for a year now. Other sexual health clinics are open. Why is Ireland's only sexual health clinic for gay & bi men & trans folks still closed? Take action: go to http://actupdublin.com/open-gmhs-now . Let the HSE know it's been long enough-it's time to #OpenGMHSNow."

Please take a minute out of your time to let the person with the power know that the #GMHS is an essential service that absolutely NEEDS to reopen immediately!
Just click the link below! #OpenGMHSNow https://t.co/0OosNpoAN0

- Noah Halpin (@Noah_Halpin) March 16, 2021

While speaking about the #OpenGMHSNow campaign, activist Leavitt expressed, "Coming up on a year, it's time to get louder."

Leavitt went on to speak about how these services go beyond testing and provide up-to-date community-driven research data as well as counselling services. In regards to a reopening, he said, "There's a lot of potential in the GMHS beyond swabs and blood draws and test for STIs [that] the HSE doesn't seem to be enthused or recognise the potential for."

On March 9 2020, the Man2Man programme shared an update on the GMHS, which reads, "A phased reintroduction of STI services is currently underway and will be delivered in accordance with current Public Health COVID guidelines. [...] PrEP Clinic: open for returning GMHS PrEP patients only." After a year of closure for the GMHS, this step forward was welcomed, however many also acknowledge that it still does not go far enough in addressing the current issue.

This is good news.

Update as of 9 March on #GMHS

"A phased reintroduction of STI services is currently underway and will be delivered in accordance with current Public Health COVID guidelines.

PrEP Clinic: open for returning GMHS PrEP patients only" https://t.co/db05cMyfVR pic.twitter.com/YHSKkSwMBH

- Man2Man Programme (@Man2ManIreland) March 11, 2021

In response to the phased reopening, Leavitt stated, "There's no change for people in the community who have been denied access to these services. The phase reopening language, it's just a meaningless way to suggest to people that the clinic is reopening, whatever that means. It's incredibly slippery and vague."

Further highlighting the need to fully reopen GMHS, the Gay Health Network (GHN) released a powerful statement urging the HSE to take action in late 2020. They wrote, "We are especially concerned that the closure, coupled with the continued increase in diagnosed STIs will have a negative impact particularly on the more vulnerable members of our community who relied on the service, including younger men, sex workers, migrants, trans people and non-binary people."

The Gay Health Network (GHN) has released a statement to the @HSELive Ireland with regard the ongoing closure of the Gay Men's Health Service (GMHS).
You can also read the full statement here: https://t.co/tyFaxbFAIW @HIVIreland #ReopenGMHS pic.twitter.com/uo1hqdhqAr

- Man2Man Programme (@Man2ManIreland) October 16, 2020

Numerous other LGBTQ+ driven organisations joined GHN and ACT UP Dublin in their call for the reopening of the GMHS. Community leaders, such as Amach! LGBT Galway, BeLonG To, Bi+ Ireland, Dublin Lesbian, and TENI, published an open letter, in which they state, " GMHS is a key health service catering specifically to the needs of GBMSM and many members of our community rely on it to receive appropriate healthcare in a safe setting. Yet, it is also the only sexual health service in the country that has not reopened."

For more information on the continued closure of the GMHS, you can check out GCN and ACT UP Dublin's special edition of In & Out down below:

© 2021 GCN (Gay Community News). All rights reserved.

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Continued closure of GMHS highlights glaring lack of accessibility in Irish sexual healthcare

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The closure of the Gay Men's Health Service (GMHS) split a chasm between the LGBTQ+ community and accessible sexual healthcare in Ireland. From March 2020 onwards, activists, artists, researchers, organisations, and so many more have voiced their deep concerns about the consequences of the HSE neglecting these vital services.

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‘Analysis: Collapse of voluntary disability providers is major worry for HSE’ - The Irish Times

Why is this interesting?
Many disability services in Ireland are provided by voluntary organisations which receive funding from the HSE. However, often these groups do not receive sufficient financial support to run adequate services and they now have an estimated collective deficit of between €30m-€150m. The Department of Health has still not made a decision on how to tackle this issue. Many vital services are teetering on a knife edge this year, St John of God Community Services being a very significant example.

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Over the past year, as it dealt with Covid-19, another major worry for the HSE was the potential for the collapse of one or more of the organisations providing disability services, and the implications of such a development for the thousands of people who relied on them.

In the majority of cases, disability services, such as residential, respite care and home support, are not provided by the HSE directly but rather by voluntary organisations which receive funding from the Government.

However, the financial position of some of these organisations is believed to be precarious with a number having millions of euro in accumulated deficits on their books.

Many maintain these deficits were incurred as a result of the amount of State funding provided over the year not being sufficient to cover the level of services which they were required to provide.

A worst-case scenario would see one of these organisations go under very quickly, leaving the State scrambling to try to sort out alternative arrangements.

Just over a year ago senior health service management warned the HSE board that a number of organisations providing services to people with disabilities were struggling financially and may not be in a position to keep going.

At the end of July the HSE's chief executive, Paul Reid, in letters to top officials in the Department of Health and the Department of Children flagged "serious concern" about the deteriorating financial position of a number of organisations.

He said there was "now a systemic challenge" in terms of both legacy deficits and in-year financial overruns and the Government should put in place "incentives" to facilitate the consolidation of some voluntary agencies - known as Section 38 and Section 39 organisations in the sector.

The HSE's own internal risk register warns of the threat to continuity of service and the provision of safe, appropriate and quality care for people with disabilities as a result of deficits in the current operational delivery model.

St John of God

The concerns appeared to be apposite. In September St John of God Community Services told the HSE it had decided to cease running the majority of its healthcare services, due to a funding crisis, and would transfer responsibility to the HSE over a 12-month period.

It said it was facing a financial deficit of more than €37 million.

St John of God Community Services, part of the wider SJOG Hospitaller Services Group, is funded by the HSE to provide services to 8,000 children and adults.

Within the HSE there was concern at the development. A special meeting of the organisation's risk committee considered the issue last October. HSE management sought legal advice on the obligations on St John of God Community Services and on its structure with a view to looking at how assets could be returned to the State.

Committee members sought a briefing paper on assets that had been provided to the organisation by the HSE and the Department of Health.

The members asked about the risk of St John of God Community Services ceasing to provide services before the expiry of the 12-month notice period.

Management said this seemed unlikely but if it did happen "it would be due to insolvency".

The HSE did provide funding - of more than €139 million - to St John of God Community Services to run its services up to September 30th this year. There was also additional money to deal with Covid-19 and staff were informed that this, "together with reduced costs associated with the necessary closure or curtailment of services and the redeployment of staff to residential services, resulted in a surplus for 2020, which enabled us to reduce our accumulated deficit to €32.5 million from €37.5 million at the end of 2020".

However, the organisation maintained that despite the reduction, the scale of its deficit remained "a cause of significant concern".

Funding crisis

Staff were informed that in discussions the HSE had hinted there may be some developments coming. It said the HSE had "referenced bringing a resolution to the funding crisis".

However, there would appear to have been insufficient progress to deal with the deficit and this led to the direct letter to the Minister for Health Stephen Donnelly warning of the potential for "liquidation as either a solvent entity or otherwise".

It is highly unlikely the State could deal with the legacy deficits of just St John of God Community Services. It would have to address the debts of all such providers.

However, first it would have to know the amount of money it could be talking about.

The HSE report to its board in March 2020 referred to a limited analysis it had carried out showing collective financial deficits of about €30 million. However, this is likely to be an under-estimate of the real situation.Within the sector some senior figures believe the total deficits could be €150 million or more.

HSE risk committee members were told by management last autumn that it was likely an independent review of the financial deficits of legacy providers may be commissioned by the Government, although it said this had yet to be confirmed.

The Department of Health told The Irish Times last month it could not confirm that a review of legacy financial deficits in disability service providers was planned.

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Analysis: Collapse of voluntary disability providers is major worry for HSE

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Over the past year, as it dealt with Covid-19, another major worry for the HSE was the potential for the collapse of one or more of the organisations providing disability services, and the implications of such a development for the thousands of people who relied on them.

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This article discusses the heavy demand for mental health and suicide services during the Covid-19 pandemic.  Due to the mental effects of the pandemic from the isolation, lack of social interaction and personal fears of the virus, the people in Ireland is depending on the healthcare system for help. This raises some issues in the deliverance of healthcare services in putting the health safety of the people who are affected by covid directly and indirectly

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Demand for mental health supports and suicide prevention services have soared across Ireland during the 13-month Covid-19 pandemic.

he revelation from Ireland's first Professor of Public Mental Health, Prof Ella Arensman, has verified mounting anecdotal concerns that the pandemic is having a significant mental health impact through extended isolation, lack of social interaction, financial stress and personal fears about the virus. Studies are now under way to determine the impact successive pandemic lockdowns have had on mental health. Suicide statistics for 2020 will not be available for three years.

However, while there is anecdotal evidence of a surge in mental health-related pleas for help during the pandemic, there is no indication the number of suicides has soared significantly above levels experienced pre-Covid-19 in 2018 or 2019. GPs revealed that pleas for mental health supports over the past year have been linked to loneliness, isolation, depression, stress over financial issues and emotional problems due to loss of a loved one in the pandemic.

Medical experts warned that such feelings have been amplified by the loss of normal processing systems during the pandemic such as funerals, social gatherings and household visits.

Prof Arensman has worked for over 30 years on public mental health and suicide prevention research. "Since the start of the Covid-19 pandemic last year, the attention for public mental health and suicide prevention has been greater than ever," she said.

"My colleagues and I in the National Suicide Research Foundation and School of Public Health have seen a significant increase in requests for policy briefings and research collaborations over the past year. For example, the requests for real-time suicide and self-harm data to inform mental health promotion and suicide prevention programmes during Covid-19 have increased over the past year.

"Requests for mental health expertise in interdisciplinary research consortia focusing on intervention and prevention measures for infectious diseases and other public health emergencies have also increased." Prof Arensman said it was "a great honour" to become Ireland's first Professor of Public Mental Health.

"This position is timely and will contribute to strengthen suicide prevention research and public mental health in the NSRF, School of Public Health, UCC, and at national and international level," she said.

Prof Arensman will continue in her current role as Chief Scientist at the National Suicide Research Foundation (NSRF), while leading groundbreaking research on suicide and self-harm within UCC's School of Public Health.

UCC's Dean of the Public Health School, Prof Ivan Perry, said it was an enormously important appointment.

"Prof Arensman is a global leader in public mental health who has made an enormous contribution to work on the causes and prevention of self-harm and suicide in Ireland and internationally," he said.

As well as being an expert advisor for the World Health Organisation (WHO), Prof Arensman is a former President of the International Association for Suicide Prevention, is Vice President of the European Alliance Against Depression, and a Steering Group member of the International Covid-19 Suicide Prevention Research Collaboration.

Online Editors

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Demand for mental health and suicide prevention services soars during Covid-19 pandemic

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Demand for mental health supports and suicide prevention services have soared across Ireland during the 13-month Covid-19 pandemic. he revelation from Ireland's first Professor of Public Mental Health, Prof Ella Arensman, has verified mounting anecdotal concerns that the pandemic is having a significant mental health impact through extended isolation, lack of social interaction, financial stress and personal fears about the virus.

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Israel and Chile both led on Covid jabs, so why is one back in lockdown?

This article looks at the vaccination success of Israel and investigates why Chile, which has vaccinated more than a third of its population is going back into lockdown. It also explores access to vaccinations and discusses why equality of access does not necessarily mean equality of uptake.

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As mass vaccination programmes take hold around the world, some countries have begun to get on top of the virus while others have continued to struggle. Two countries that have streaked ahead with immunisations are Israel and Chile, but as Israel edges back to a new normal, Chile has been plunged back into lockdown. Can the UK and other countries repeat Israel's success and avoid the setbacks of Chile?

What is happening in Israel?

Israel has recorded dramatic falls in rates of infection, hospital admissions and deaths after running what was the world's fastest Covid vaccination campaign. The country of 9 million people has administered two shots of the Pfizer/BioNTech vaccine to more than half its population. Daily life has returned almost completely to a pre-pandemic situation, with shops, hotels, concerts and cinemas open again. That said, restrictions are still in place, such as the need for face masks outside the home and limits on gatherings indoors.

An analysis by Eran Segal, a computational biologist at Israel's Weizmann Institute of Science, reported that since a January peak in infections, the country had seen daily drops of 96% in cases, 90% in critically ill patients and 85% in deaths. According to health ministry statistics, daily infections have plummeted to the low hundreds - a massive decline since January, when there were 10,000 confirmed infections a day at one point. On Tuesday, the total number of active cases was roughly half that figure.

What is happening in Chile?

Chile is in the enviable position of having vaccinated faster than any other country in the Americas. More than a third of the country's 18 million people have received at least one shot of either Pfizer/BioNTech or China's Sinovac Biotech vaccine. However, cases have soared to the point of overwhelming the health system and strict lockdown measures are back in place.

What went wrong?

The speedy vaccination programme appears to have instilled a false sense of security that led the country to ease restrictions too soon without people appreciating the ongoing risks. The country reopened its borders in November and in January introduced permits for Chileans to go on summer holiday. Without strict controls on people entering the country, and the lack of an efficient contact-tracing system, travellers may have brought infections back into the country that were not picked up.

The virus would have had more chance to spread when the schools reopened along with restaurants, shopping malls, casinos, gyms and churches. With transmission rates now so high in the country, a far greater proportion of the population will need to be vaccinated to get on top of the epidemic.

Are the two countries comparable?

Israel's case has a key difference to that of Chile's in that it has exclusively administered Pfizer/BioNTech vaccine, whereas Chile is using Pfizer/BioNTech and Sinovac Biotech shots. It is unclear what difference, if any, that may have, but the Pfizer/BioNTech vaccine has been one of the strongest performers in clinical trials. Other differences between the countries - with vastly different societies and demographics, and possibly different virus variants in circulation - can also make comparisons misleading.

It may also be a question of time for Chile. While Israel is enjoying low infection rates now, the effect of the vaccine appeared to have taken longer to establish itself than first thought. In fact, the country suffered its worst rise in infections during the pandemic even after its vaccine drive was in train, with a strict and weeks-long lockdown imposed. That lockdown, similar to the one just put in place in Chile, will also have had an effect on infection rates.

Can the UK achieve what Israel has done?

The UK's vaccination programme has been a rare highlight in an otherwise disappointing response to the crisis. Having secured early deals for vaccines from multiple manufacturers, the country started inoculations in December and ramped up rates into the spring. More than half of the adult population has now received at least one shot of either the Pfizer/BioNTech or Oxford/AstraZeneca vaccine, with coverage standing at more than 90% in the most vulnerable over-70s.

But the UK can easily blow it. Prof Chris Whitty, England's chief medical officer, has said there will definitely be another surge in coronavirus when the UK comes out of lockdown. What is unclear is how bad the resurgence will be and when it will peak. Documents released on Monday by the government's Sage experts suggest a third wave could peak in late July or August, with one pessimistic but plausible scenario anticipating a situation as severe as that experienced in January when half of all UK Covid deaths occurred. A major driver for that bleak outcome would be if the AstraZeneca vaccine turns out to be less effective at reducing infection, limiting its impact on the spread of the disease.

Difficulties over vaccine supply already threaten to slow the UK's immunisation programme and scientists modelling the epidemic say that if a slower rollout is not balanced by a slower relaxation of restrictions, we will see more hospital admissions and deaths in any further wave.

Whether the UK can emulate Israel's apparent success comes down to multiple factors. It is unclear how big a part is played by the vaccines used. Outbreak modellers on Sage assume that the Pfizer vaccine is more effective at preventing infections - and so reducing spread of the virus - than the Oxford/AstraZeneca vaccine. But there is little real-world data on the potency of the AstraZeneca vaccine when two shots are given three months apart, as is the case in the UK. The initial picture is that the delay improves the immune response, but the impact in the real world is unclear.

Differences in the vaccines are only one factor though. Unlike Israel, the UK is a global travel hub. This makes it much tougher to drive cases down to very low levels without strong - and highly disruptive - protection at the borders. This means cases are likely to be higher when the UK eases restrictions, meaning the epidemic could swiftly pick up again in the millions of people who have not been protected by vaccine.

Both Israel and the UK need to address differences in cultural behaviour, access to vaccines, housing density and vaccine hesitancy. Israel turned to free pizza and beer to encourage younger people - who are less at risk from the virus - to have the vaccine and similar enticements might work in the UK. Patterns of vaccine coverage in the UK show that the immunisation programme could easily result in a patchwork of high and low vaccination areas, with the disease more under control in richer regions and persisting in the more deprived areas.

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Israel and Chile both led on Covid jabs, so why is one back in lockdown?

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As mass vaccination programmes take hold around the world, some countries have begun to get on top of the virus while others have continued to struggle. Two countries that have streaked ahead with immunisations are Israel and Chile, but as Israel edges back to a new normal, Chile has been plunged back into lockdown.

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This was an interesting article which compared Northern Ireland and Republic of Ireland healthcare systems.
While the healthcare services of both have some big differences, they also face similar problems.

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How two different, expensive healthcare systems on this island have managed to (occasionally) work well together

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An all-island milk bank, children's heart care, and cancer treatments has brought benefits - but research is needed for further health collaborations.

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This article describes a woman who has cystic fibrosis and received a new NHS treatment which she describes as giving her 6 years of her life back. She is one in 80 people in wales who have received the Kaftrio revolutionary drug treatment. Prior to this treatment this woman was significantly ill and on a continuous oxygen supply, nearly on a ventilator and considered for a lung transplant at only 31 years of age. She had to completely change her life and give up things she loved to do the most. Within one week of the treatment she began to see results and no longer needed the six oxygen tanks a day and says she feels as good as she did 6 years ago prior to falling seriously ill.

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A woman who has cystic fibrosis (CF) says a new NHS treatment is like "regaining six years" of her life.

Jody Lewis, 31, is one of around 80 people in Wales to have had Kaftrio, a "revolutionary" drug treatment, at Liverpool Heart and Chest Hospital.

The treatment is suitable for around 90% of CF patients aged 12 and over and has been approved for use in the UK.

Ms Lewis, who lives in Pen-y-Lan near Wrexham, said since taking it she had "a whole future and life" ahead of her.

When Kaftrio was approved in Wales last July, Health Minister Vaughan Gething said it should help more than 400 patients.

Cystic fibrosis is a genetic condition which causes a build-up of thick, sticky mucus in the lungs, digestive system and other organs.

Ms Lewis became more seriously ill with her condition around two and a half years ago, when she was put on continuous oxygen supply, almost placed on a ventilator and considered for a lung transplant.

This meant she had to stop riding and change how she looked after her four dogs at home.

"I'd have to change my complete lifestyle just to survive.

"I get that I'd have a second chance at life but it wouldn't be me, it wouldn't be true to who I am," she said.

Ms Lewis said she would go through "four, maybe five bottles of oxygen a day", and at her worst, she needed it for everything - such as sitting watching television or making a cup of tea.

"I didn't tend to go very far because it was just hard work," she said.

However, when she began taking Kaftrio last year during treatment in Liverpool, she soon began to see results.

"Within a week, my [oxygen saturation] was going up and up to 94, 96 and I wasn't even on oxygen and I can't remember the last time I saw those numbers, it was mad.

"I'm now as good as I was back when I was 25, so I've like regained six years of my life," she said.

"When I was 25 I was fine, I was in work, living a normal life, so it's given me all that back really."

'Absolutely revolutionary'

Ms Lewis said it was "really emotional" and "fantastic" to be able to ride her horse again after two and a half years, and now she is thinking of returning to showjumping.

"I've got a whole future and life in front of me that I've never had to think about."

Consultant Martin Ledson, the clinical lead for respiratory medicine at Liverpool Heart and Chest Hospital, described the drug treatment as "absolutely revolutionary" and said it had transformed the lives of 222 of the hospital's patients.

He said when his patients were born, their life expectancy was in their 30s, so they have "lived all their lives with the knowledge that their life expectation could be 30 or even less".

"What this drug does is extend that life expectancy who knows how long?

"Not only that, the patients immediately - within 24 hours - feel amazingly better. Their breathing tests improve, they get less chest infections, their digestion improves, they put on weight and in many cases need to take less treatment," he said.

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Cystic fibrosis drug treatment Kaftrio like 'regaining six years'

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A woman who has cystic fibrosis (CF) says a new NHS treatment is like "regaining six years" of her life. Jody Lewis, 31, is one of around 80 people in Wales to have had Kaftrio, a "revolutionary" drug treatment, at Liverpool Heart and Chest Hospital.

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What is the article about?
The new digital technologies designed to tackle the Covid-19 pandemic could be worsening the digital divide between some of the UK’s most disadvantaged communities.

Why is this article interesting?
This article highlights that the new digital health technologies such as symptom-tracking, contact-tracing or mental and physical health apps used during the pandemic can exacerbate inequalities in access, knowledge and awareness of these technologies. The UK survey shows that almost 19 per cent of the UK population reported not having access to a smartphone, a further 14 per cent did not have access to broadband internet, and 60 per cent of the public had not yet heard of symptom-tracking apps.

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Technologies designed to tackle the Covid-19 pandemic, such as contact-tracing apps, could be worsening the digital divide between some of the UK's most disadvantaged communities, the Ada Lovelace Institute has said.

In its report, the Ada Lovelace Institute found a 'data divide' of inequalities in access, knowledge and awareness of digital health technologies used in the pandemic, such as symptom-tracking apps, contact-tracing apps and consumer-facing mental and physical health apps.

It also found that over half the UK public is concerned about the potential discriminatory impact of vaccine passports.

Around one-fifth (19 per cent) of the UK population said they do not have access to a smartphone, while another 14 per cent does not have access to broadband internet. Meanwhile, 60 per cent of the UK public has reportedly not heard of symptom-tracking apps, such as the Zoe Covid Symptom Study, and just over half had not heard of the availability of online medical appointment services.

Over half (54 per cent) think it is likely that vaccine passports would lead to discrimination against marginalised groups.

The findings of the survey, formed from a poll of 2,023 adults, highlights a stark divide in people's experiences of technology used during the pandemic.

The top reasons cited for not using these technologies related to concerns around accuracy and effectiveness. People with disabilities were also less likely to feel such apps would be effective for them.

The Institute called on policymakers and technology developers to place greater emphasis on understanding the attitudes of the wider population before and during implementation of digital health technologies in order to ensure greater public trust.

Carly Kind, director of the Ada Lovelace Institute, said: "The long-researched 'digital divide' risks transforming into the 'data divide', as data-driven technologies developed in response to the coronavirus pandemic - such as vaccine passports, symptom-tracking apps, and digital contact-tracing technologies - benefit, represent and respond to the needs of some people and some groups more than others.

"These findings show that we as a society need a much more inclusive approach to developing data and data-driven systems."

Adam Steventon, director of data analytics at the Health Foundation, said: "Advances in the development and use of data-driven technology could play a critical role in supporting the recovery and improvement of NHS and social care services, as well as the health of the population, in the wake of the Covid-19 pandemic.

"Decisions made now about how these technologies are designed and deployed will set the precedent for how this happens in the future. However, these survey findings highlight the risk that technologies can exacerbate health inequalities, negatively impacting the most vulnerable and disadvantaged."

Sign up to the E&T News e-mail to get great stories like this delivered to your inbox every day.

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Covid-19 tech risks widening the digital divide, experts warn

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Technologies designed to tackle the Covid-19 pandemic, such as contact-tracing apps, could be worsening the digital divide between some of the UK's most disadvantaged communities, the Ada Lovelace Institute has said.

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This  news article  was very  interesting, it discussed the equity and inequality  problem that rough sleepers face  in terms of assessing mental health  facilities.

As Covid-19 has limited the number of public places rough sleepers maintain their hygiene. It has taken a total on their mental health as they feel even more social excluded in society as an element of their physiology needs have been cut off. This has increased the amount of individuals who attended drug rehabilitation services and counselling  service for rough sleepers, which is now  in high demand. They under resourced and under staffed for these new high demands. Rough sleepers cannot enter traditional mental health facilities and  some do not have phones to access online resource to help with  their mental health.

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Lack of shower and toilet facilities exacerbating mental health issues for Dublin's rough sleepers

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Dublin's rough sleepers have been relying on the two public toilets locations in the city centre.

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The article highlights the HSE's step in making multilingual videos about the roll out of vaccines for migrant communities in Ireland.

Why is it interesting?
This article shows the attempt in patient inclusivity from the HSE's Social Inclusion Office and the National Immunisation office. Making multilingual videos increase the chances for accessibility for health information about COVID-19 vaccine during this difficult time. I thought that this campaign was very well thought, when keeping in mind that not everyone in Ireland speaks and understands English. Overcoming the language barrier between healthcare workers and patients can ensure a better efficient care quality for the people.

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A multilingual video service with information on the Irish Covid-19 vaccination rollout from international doctors, nurses and healthcare workers was published on Wednesday, as part of a campaign to make health advice more accessible to Ireland's migrant community.

The videos, which have been produced in 36 languages, offer culturally appropriate, clear information on the State's vaccination programme along with other important health and safety information relating to the pandemic.

The Translate Ireland company started its multilingual information campaign last December through a series of videos offering advice on health, education and other social services to the Irish migrant community.

Its latest vaccine information project was commissioned by the HSE's social inclusion office and the National Immunisation Office, with support from the Irish College of General Practitioners.

Medical professionals took part to communicate public health information in different languages. Photograph: Translate Ireland

It features videos presented by consultants, surgeons, general practitioners, nurses, psychotherapists and medical health researchers who live in Ireland but moved here from abroad, speaking in languages including Albanian, Bengali, Croatian, Filipino, Hungarian, Lingala, Moldovan, Pashto, Russian, Spanish, Ukrainian and Urdu.

Co-founder of Translate Ireland Graham Clifford, who also leads the Sanctuary Runners charity, warned that a shortage of multilingual resources could result in a poor uptake of the Covid-19 vaccine among migrant communities.

The Translate Ireland project will help disseminate information to people who might otherwise miss mainstream information campaigns or struggle with literacy, said Mr Clifford.

"There are many migrants here, and across the world, who will not consume local media or be aware of local health programmes and initiatives," he added.

Medical lead on the project Dr Catherine Clifford, agreed that spreading accurate information among all communities was "essential for confidence in vaccines".

"In the context of a pandemic its so important for everyone that information reaches all sections of society - including those for whom English is limited."

According to the 2016 census, more than 86,600 people in Ireland speak English "not well" or "not at all".

The 2016 census also revealed 612,018 people spoke a foreign language at home. Polish was the most common language followed by French, Romanian and Lithuanian.

Public health messaging

Dr Eva Chende, a GP based in Co Louth, who presents one of the videos in Romanian, admits she worried when the pandemic first hit that foreign nationals would struggle to understand the HSE's public health messaging.

"I felt there were mountains of information online with difficult-to-understand resources. Lots of slang, words with double meaning, unusual language. I was wondering how many Romanians in Ireland would understand half of it.

"By crossing the language barrier and using heart-to-heart speaking, Translate Ireland is a crucial resource for everyone in society."

Dublin GP Dr Stella Burksa, who presents in Slovakian, described the videos as a "unique opportunity to deliver a clear evidence-based message about the Covid-19 vaccine" to those who, due to language or other barriers, are unable to seek public health advice.

"These disadvantaged groups can often seek information on social media, which sometimes can be a source of misinformation and confusion," she said. "We sincerely hope that spreading this information in our community's own language will help to increase Covid 19 vaccine uptake."

Cork GP Dr Sura Aldeen agreed that reassuring Muslim Arabic speakers in Ireland that the vaccinations are "halal and safe" would "definitely increase the vaccine uptake among migrants in Ireland".

Brazilian paediatrician Dr Taciane Alegra noted that public health strategies, particularly around vaccine rollout or preventing the spread of infections, only work through engagement with all individuals in the community.

"It is so relevant to engage migrants, talking to them in a way that not only they can understand, but also in a way that they feel part of the society and engage to play their role," said Dr Alegra.

"Amid challenging days for migrants, Ireland is showing an example of engagement and acceptance of other human beings, independent of their motherland."

Translate Ireland's vaccine information videos will be available to watch from Wednesday on TranslateIreland.ie, with additional video presentations on Covid-19 safety in the workplace, Covid-19 testing at work, mental health during the pandemic and explanations on the State's Covid-19 five-level system.

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Multilingual videos about vaccines launched for Ireland's migrant community

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A multilingual video service with information on the Irish Covid-19 vaccination rollout from international doctors, nurses and healthcare workers was published on Wednesday, as part of a campaign to make health advice more accessible to Ireland's migrant community.

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This article is about a new, Slaintecare funded programme in North Dublin which integrates several services into one with the aim of providing elderly peolple with alternatives to being brought to the Emergency Department and avoiding ultimately hospital stays.

This story is interesting because it hightlights that hospitals are often not necessary or appropriate in meeting the needs of the elderly population, as well as the importance of expanding projects like this one to cope with an increasingly aged population.

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Presentation to emergency departments for elderly people increases the risk for elderly patients of experiencing an adverse event, such as pressure ulcer, infection, adverse drug event, functional decline, delirium or a fall. It can result in patient dissatisfaction, increased hospital length of stay, increased confusion and increased mortality.

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Pathfinder Service - A new way to care for elderly people making 999 calls

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Presentation to emergency departments for elderly people increases the risk for elderly patients of experiencing an adverse event, such as pressure ulcer, infection, adverse drug event, functional decline, delirium or a fall. It can result in patient dissatisfaction, increased hospital length of stay, increased confusion and increased mortality.

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World Health Day (7 April): Putting equity at the heart of COVID-19 recovery.

This is a very good summary outlining key issues, highlighted by the pandemic, and what needs to be done coming out of this period.

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World Health Day: Putting equity at the heart of COVID-19 recovery

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COVID-19 has affected us all, but some have fared worse than others simply because of the jobs they do and the insecurity of their living conditions and livelihoods. People who have been hit the hardest are also among those least protected by national policies and systems, and the pandemic has brought their precarious situation into sharp focus.

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This article is insightful as it shows the inequity of the global vaccinations how it is devastating.  As some countries around the world still don't have the access they need to the vaccine for people who are vulnerable and for healthcare workers.

https://www.rte.ie/news/coronavirus/2021/0406/1208099-coronavirus-global/

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Britain's Covid-19 vaccine programme is challenging due to supply constraints but is set to meet its targets, the minister responsible for rolling out the shots said, adding that 12 million second doses would be distributed this month.

"Supply is always challenging and supply is finite as you're seeing around the world. But I'm confident... that we'll meet our targets," Nadhim Zahawi said.

He also said that Covid status certification scheme that the UK adopts has to be workable and must not discriminate against people who are not vaccinated.

"Everyone can get a test. There is no discrimination. Not everyone can get a vaccine ... which is why we've got to look at all the technologies to make sure they work together," he said.
Latest coronavirus stories
Mr Zahawi said Britain will begin the roll-out of Moderna's Covid-19 vaccine in mid-April.

Bogota to impose lockdown as Covid-19 cases rise in Colombia

Eight million inhabitants of Bogota will be put under strict lockdown from Saturday, mayor Claudia Lopez said as the Colombian city battles a third wave of the coronavirus pandemic.

"This weekend, Saturday, Sunday and Monday, we are all going to stay at home... In all of Bogota, only strictly essential activities will be allowed," Ms Lopez said in a video posted on Twitter.

A third wave of Covid-19 had already started and it depended on people's behavior whether they could get it under control, the mayor warned in a statement, adding that the restrictions could be extended next week.

The measures are in addition to night curfews imposed the day before by the government that cover seven million people in the cities of Medellín, Cali, Barranquilla and Santa Marta, where the health system is overwhelmed by the virus.

A nurse moves doses of China's Sinovac vaccine at a clinic in Bogota

Since the end of March, Colombian authorities have imposed and tightened nighttime restrictions in an effort to stop a new outbreak.

However, infections and deaths have continued to rise and there is concern about the effect of the Easter holidays, traditionally a popular time to travel in Colombia.

The South American country has so far administered at least one dose of Covid-19 vaccine to 2.4 million of its 50 million inhabitants.

Colombia has the second most cases in Latin America at more than 2.4 million, behind Brazil, and the third most deaths (64,293), after its neighbour and Mexico.

German CDU chairman calls for tougher lockdown for 2-3 weeks

Germany should impose tougher lockdown measures for two to three weeks to bridge the gap until a greater share of the population is vaccinated, the chairman of Angela Merkel's Christian Democrats (CDU) said.

Armin Laschet said "another effort" was needed to try to reduce the incidence of the virus to below 100 cases per 100,000 in which compulsory testing, digital contact tracing and model projects to reopen the economy would then be possible.

"Then we can enter the new period where we can carefully reopen," Mr Laschet, who is premier of Germany's most populous state of North Rhine-Westphalia, told ZDF television.

People wait at a vaccination centre in Cologne

He did not elaborate on which specific measures should betaken in the three week period. yesterday, he called for fewer private contacts, which could require curfews at night, and for more people to work from home.

Germany, despite months of restrictions, has seen a rise in infections as it lags Britain, Israel and the United States in the pace of vaccinations.

It reported 6,885 new confirmed coronavirus cases within 24 hours, data from the Robert Koch Institute (RKI)for infectious diseases showed today.

The incidence of the virus per 100,000 fell to 123 from 128 yesterday.

The RKI noted, however, that the number of reported cases may be lower as less testing was carried out over the Easter holiday.

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UK's vaccine minister says targets will be met

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Britain's Covid-19 vaccine programme is challenging due to supply constraints but is set to meet its targets, the minister responsible for rolling out the shots said, adding that 12 million second doses would be distributed this month. "Supply is always challenging and supply is finite as you're seeing around the world.

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This article is interesting because it discusses a new Irish co-founded start-up that is looking to provide an alternative to IVF. The founders are seeking to "democratise" access to affordable and effective fertility treatments for couples who are struggling to conceive. The new at-home treatment will cost €352 per month as opposed to between €6000-€10,000 for IVF, therefore increasing access to affordable fertility treatments.

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Béa Fertility, an Irish co-founded start-up, is looking to provide an alternative to in vitro fertilisation (IVF) for those struggling to conceive with an at-home fertility treatment that will be offered via a monthly subscription.

The London-based company founded by embryologist David O'Rourke and femtech specialist Tess Cosad, has just raised $1 million (€850,000) in seed capital ahead of its launch later this year.

The founders say they are looking to "democratise" access to affordable, effective fertility treatments for couples and individuals who are struggling to conceive. IVF may be both too expensive for some of these people and can take a huge physical and emotional toll on those involved.

While initially focused on Britain, Mr O'Rourke said the company was interested in making its subscription service available in Ireland as well.

"We are aiming to provide this service locally and we are currently in the process of getting regulatory approval in Europe, " he said.

IntraCervical Insemination

Infertility is estimated to affect one in seven hetersosexual couples in Ireland and Britain. A cycle of IVF locally usually costs between €6,000 and €10,000 in Ireland depending on which treatment is required and which clinic is used. Currently, there is no financial support for those turning to the treatment, other than tax relief. While support is more readily available in Britain, there are strict criteria as to who is eligible for it.

Béa's clinical-standard fertility treatment enable couples to carry out intracervical insemination (ICI) at home. The service, which will cost about £300 (€352) a month, involves placing a small cup of semen close to the cervix for two consecutive days in a month - a strategy called double insemination - and leaving it there for four to 12 hours. During that time, women can go about their days normally.

The start-up says its service improves the chances of conception by 40 per cent if used over three months, and by as much as 60 per cent if used over six months.The subscription service involves ICI devices, ovulation tests, pregnancy tests, and access to an app to help track ovulation dates and the progress of their fertility journey.

'Highly effective'

"The great thing about taking a different approach to treating infertility, as we are doing, is that the treatment comes to the user in their home so if you have a postal address you have access, and we want to provide access to everyone in need," said Mr O'Rourke.

"The situation in Ireland is different when compared to the UK, worse you might even say," the Dubliner said.

Mr O'Rourke said the start-up has gone through over 90 design iterations of its ICI device to reach the right balance of effectiveness and user-friendliness.

The British government-backed Innovate UK is among Béa backers.

The company said it intends to use the financing it has secured to take its product from prototype stage through clinical studies. It hopes to formally launch the subscription service later this year.

"ICI is clinically proven to be highly effective when it comes to increasing the chances of conception, but it's not made available to people at the beginning of their fertility journey. Instead, they have to take a big leap into the expensive world of invasive treatments. But for people where there's no medically identified issue causing infertility, ICI can be the ideal way of maximising their chances of getting pregnant," said Ms Cosad.

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Irish co-founded start-up to 'democratise' fertility treatment with at-home service

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Béa Fertility, an Irish co-founded start-up, is looking to provide an alternative to in vitro fertilisation (IVF) for those struggling to conceive with an at-home fertility treatment that will be offered via a monthly subscription. The London-based company founded by embryologist David O'Rourke and femtech specialist Tess Cosad, has just raised $1 million (€850,000) in seed capital ahead of its launch later this year.

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Final Week- Tim Wehr

“Nearly 60% say mental health hit by pandemic - CSO”

This article details some of the latest figures from the fifth Social Impact of Covid-19 survey. Shocking responses speak to the severity of the pandemic’s effects on our nations mental health.

Why is this article interesting?

This article displays in stark figures, just how much of an impact the pandemic has had on our nations mental health. The survey paints a bleak picture, showing an increase of 9.5% of respondents stating they are downhearted or depressed "all or most of the time" since last April. Perhaps most worrying is “The number of people who believe their life will never return to normal has doubled - up from 4.3% to 8.9% - in the three months to February.”

This article shows the very real crises of mental health that our nations health care system must be prepared to deal with in the coming future. The effects of this crisis are likely to need action at a policy level to accommodate the increasing number and servery of cases.

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Almost 60% of people say their mental health has been impacted by the pandemic, with younger people more likely to have experienced recent difficulties with their well-being.

The fifth Social Impact of Covid-19 survey, from the Central Statistics Office, gives an insight into the way people's lives have changed in the last year.

The research - based on an online questionnaire with 1,621 people earlier this month - shows over 15% said they were downhearted or depressed "all or most of the time", in the four weeks before the survey.

This compares with a figure of 5.5% in a similar study last April during the first wave.

Almost three-quarters of those aged between 18 and 34 said the pandemic was having a negative impact on their mental health, compared to less than a third of those aged 70 or older.

Life satisfaction is described as "low" by over 40% of those surveyed.

Female respondents were more likely to feel lonely or report that their mental health and well-being had been negatively impacted by the pandemic.

Personal compliance with public health restrictions in February was rated as "high" by three quarters of participants, an increase of 10% since last November.

Just over 4% of those surveyed said the events of the last year had a positive impact on their mental health.

The survey shows general support for the present Level 5 restrictions, but more than 60% of respondents believe that similar measures will have to be reimposed sometime before the end of this year.

In a similar survey last November, 40% of people thought their lives would be back to normal within a year.

Now, just 24% are expecting a return to pre-Covid life by November of this year.

The number of people who believe their life will never return to normal has doubled - up from 4.3% to 8.9% - in the three months to February.
Latest coronavirus stories

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Nearly 60% say mental health hit by pandemic - CSO

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Almost 60% of people say their mental health has been impacted by the pandemic, with younger people more likely to have experienced recent difficulties with their well-being. The fifth Social Impact of Covid-19 survey, from the Central Statistics Office, gives an insight into the way people's lives have changed in the last year.

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This article discusses the effects Covid-19 has had on the education system and the challenges both teachers and students have had to face during the pandemic. The pandemic has also had an impact on peoples social lives and the mental health of students.

Why is this interesting?
The pandemic Covid-19 outbreak is responsible for a major education crisis globally as the entire world went into lockdown at the end of 2019, beginning of 2020. The spread of the disease, travel restrictions and the closure of educational facilities across the entire globe has had significant effect on the education, social life and mental health of students.

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Highlights

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The potential consequences of the COVID-19 pandemic on the life of students is investigated.

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Students of different age groups and time spent on daily life activities are analyzed.

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The mental status of students of different age groups is analyzed.

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This study suggests that public authorities should take all the necessary measures to enhance the learning experience by mitigating the negative impacts caused due to the COVID-19 outbreak.

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A wide gap is seen between government policy and the actual situation.

Abstract

The outbreak of COVID-19 affected the lives of all sections of society as people were asked to self-quarantine in their homes to prevent the spread of the virus. The lockdown had serious implications on mental health, resulting in psychological problems including frustration, stress, and depression. In order to explore the impacts of this pandemic on the lives of students, we conducted a survey of a total of 1182 individuals of different age groups from various educational institutes in Delhi - National Capital Region (NCR), India. The article identified the following as the impact of COVID-19 on the students of different age groups: time spent on online classes and self-study, medium used for learning, sleeping habits, daily fitness routine, and the subsequent effects on weight, social life, and mental health. Moreover, our research found that in order to deal with stress and anxiety, participants adopted different coping mechanisms and also sought help from their near ones. Further, the research examined the student's engagement on social media platforms among different age categories. This study suggests that public authorities should take all the necessary measures to enhance the learning experience by mitigating the negative impacts caused due to the COVID-19 outbreak.

View Abstract

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COVID-19 and its impact on education, social life and mental health of students: A survey

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The potential consequences of the COVID-19 pandemic on the life of students is investigated. * Students of different age groups and time spent on daily life activities are analyzed. * The mental status of students of different age groups is analyzed.

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This article outlines how a nursing home failed to contain a Covid 19 outbreak. They were not staffed properly and as a result were putting their residents at risk. This highlights the importance for nursing homes to follow all the correct guidelines and the implications of failing to do so. The   management had failed to " support the staff on the ground to ensure the safety of the service during this Covid-19 outbreak.”

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A publicly-run nursing home in Co Mayo failed to manage a Covid-19 outbreak and risked spreading the disease to virus-free areas, a report by the State's health watchdog has found.

The Health Information and Quality Authority discovered during an unannounced inspection on October 29th last year that there was just one staff member assigned to cleaning duties at the home during the outbreak at St Augustine's Community Nursing Unit in Ballina.

At the time of the inspection, 22 residents out of a total of 26 living in the home and 26 staff had tested positive for Covid-19 in the outbreak, which was still active when Hiqa inspectors visited.

Inspectors found that the quality and safety of residents was "significantly compromised" by inadequate oversight of infection prevention and control practices and procedures.

The inspection was carried out after concerns were raised about management at the home.

The report into the HSE-run long-term care facility in Co Mayo was one of 35 inspection reports into nursing homes published by Hiqa. The regulator found non-compliance with health regulations in 23 nursing homes, including in the areas of healthcare and infection control.

Inspectors found on the day of the inspection at St Augustine's that the home had been subdivided into two areas, one with infected Covid-19 residents and a Covid-free area.

However, inspectors found that arrangements to ensure no crossover of staff between the two areas were "not effective" and the risk of "Covid-19 cross infection was not controlled."

The facility's front entrance and reception were located in the Covid-19 positive zone but there were no signs to redirect essential visits to the Covid-19 free zone which had a separate entrance.

The Covid area had one staff cleaner, while another staff member had been asked to clean floors in the Covid-free area but there was no cleaner for other areas and equipment in this zone.

"The entire centre and equipment could not be cleaned to the standard required during a Covid-19 outbreak by one person who was redeployed into a cleaning role," the report said.

Hiqa said that there had been no "person in charge" at the centre between August 2020 and October 19th, 2020 - just 10 days before the inspection - and that the lack of a "consistent person in charge" in the weeks leading up to the outbreak contributed to problems discovered at the home.

Non-complaint

The HSE-run nursing home was found to be non-compliant under six regulations, including infection control, healthcare, and governance and management.

"Management systems in place did not ensure that the Covid-19 outbreak in the centre was effectively managed and infection prevention and control in the centre was appropriately monitored," said the Hiqa inspection report.

"Senior management had failed to adequately oversee and support the staff on the ground to ensure the safety of the service during this Covid-19 outbreak."

At another nursing home, Brookvale Manor in Ballyhaunis, Co Mayo, inspectors found on a return visit following an earlier Covid-19 outbreak that the privately run nursing home still had poor contingency plans in place to ensure adequate staffing in the event of a second outbreak.

Hiqa found that during an unannounced inspection on November 9th last the care home, run by private operator Brindley Healthcare, had failed to increase staff numbers in line with their own assessment needs following a previous inspection in June of last year during an outbreak.

At another publicly-run facility, St Joseph's Care Centre in Longford, the HSE's failure to carry out a refurbishment had left "significant non-compliances" with fire safety regulations and that an urgent action plan was required to ensure the safety of 61 residents living at the home.

The latest Hiqa reports reveal details severe Covid-19 outbreaks at some nursing homes.

Glengara Park Nursing Home in Dún Laoghaire experienced an outbreak in late March 2020 the led to 27 residents and 26 staff becoming infected and the deaths of seven residents.

Anam Cara Nursing Home in Glasnevin, Dublin suffered an outbreak in April 2020 where nine residents were hospitalised out of a total of 11 infected residents. The outbreak led to three deaths.

Twenty staff at the home became sick or had to self-isolate due to exposure to the virus.

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Co Mayo nursing home failed to manage Covid-19 outbreak - regulator

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A publicly-run nursing home in Co Mayo failed to manage a Covid-19 outbreak and risked spreading the disease to virus-free areas, a report by the State's health watchdog has found.

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This article discusses how a digital health support company have the ability to increase the benefits that come from technology-enabled care for patients, as well as for clinicians. It can produce better outcomes for patients and manage their journey efficiently.

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Marc Schmid, Redmoor Health CEO, discusses the potential of technology-enabled care to help NHS clinicians achieve the government's goal of digital transformation across the health service.

Redmoor Health is a digital health support company with a mission: to maximise the benefits of technology-enabled care (TEC) for patients and clinicians. As passionate advocates of 'digital first', this approach drives Redmoor's commitment to continuously invest in health technology services, in order to support clinicians on the frontline of health and social care.

Redmoor's range of TEC services are successfully delivering digital care solutions to manage the patient journey more efficiently and produce better outcomes for patients; and its recent partnership alliance with the Experience-Led Care Programme means it is a recognised leader in the person-centred Video Group Clinic (VGC) consultation model.

CEO Marc Schmid's extensive knowledge of the NHS landscape, coupled with a robust project delivery approach, has ensured the company's success in deploying technology-enabled care solutions which align with the NHS Long-Term Plan. He explains: "It's all about leveraging technology which enhances patient experience and increases clinician efficiency."

Throughout the COVID-19 crisis, Redmoor has worked intensely with NHS teams across England and Wales; and Schmid believes that the pandemic has allowed TEC solutions to prove their value across primary, secondary, community and social care sectors. In England, there has been a longstanding aim to harness digital technology to deliver healthcare: two years ago, the NHS Long-Term Plan set the goal for digital technology to become mainstream in primary care and outpatient services - bringing increased patient choice and empowerment, and a more person-centred care approach.

These ambitions are echoed by Minister for Health and Social Care Matt Hancock, a passionate proponent of adopting technology in the NHS. In a speech last July, he argued: "All consultations should be teleconsultations unless there is a compelling clinical reason not to...This crisis has shown that patients and clinicians alike, not just the young, want to use technology."

"I believe we cannot return to old and inefficient methods," Schmid comments. "Even before the pandemic, the NHS was facing rising demand, but digital healthcare solutions ensured continuity of care and are now playing a key role in supporting primary care clinicians. Most importantly, these solutions have been delivered at pace - and without compromising patient safety or the confidentiality of sensitive patient data. As we move cautiously towards a post-COVID way of working, it is vital that the NHS fully embraces 'digital first' technology-enabled care for the long term."

Redmoor believes general practice teams should be applauded for their agile response in adopting new primary care pathways, such as consultations via video calls and VGC consultations for groups of patients with the same long-term health conditions. Although video consultations and face-to-face group clinics were used pre-COVID, their benefits have been fully realised throughout the pandemic.

Video Group Clinics

COVID-19 and the demand it placed on the NHS required radically different thinking and new, scalable primary care solutions which could make use of existing technology. Recognising this imperative, in Spring 2020 NHS England and Improvement (NHSEI) and General Practice Nurse Ten Point Plan commissioned Redmoor-ELC to develop and roll out training and technical support for a national Video Group Clinics pilot programme across GP practices in England. Feedback from the programme indicates that the VGC pathway offers comparable benefits to real-world group consultations, especially within the context of COVID-19. The compelling clinician case studies on the Redmoor website are testament to this: showcasing the support, resilience, and empowerment VGCs bring to their patients with chronic conditions, and how they are realising up to 80% clinicians' time efficiency gains.

Redmoor-ELC's innovative work with NHSEI on implementing VGCs in primary care has been acknowledged by being shortlisted for two prestigious awards: 'Best NHS Educational Programme' and 'Most Effective Contribution to Clinical Redesign' at the Health Service Journal Partnership Awards 2021. The awards recognise 'outstanding dedication to improving healthcare and effective collaboration with the NHS.'

The value of VGCs was further acknowledged in February 2021, when the Welsh government commissioned Redmoor-ELC to deploy a VGC development support programme across all sectors of the NHS in Wales. This first-of-its-kind initiative sees the Redmoor-ELC team delivering a comprehensive support programme at pace, with practice development and technical assistance for clinical teams in general practice, the community and outpatient support.

The 'Redmoor Way'

Other innovative digital technology-enabled care offerings from Redmoor Health include a Digital Journey Planner web tool to measure organisational digital maturity; Artificial Intelligence (AI) and digital devices; support for sustainability and transformation plans; digital upskilling to help NHS staff manage workloads more efficiently; and programmes to support workforce retention. The comprehensive 'Redmoor Way' programme integrates the learning from hundreds of primary care practices the company has worked with into a support programme to help clinicians on their digital journey. Schmid comments: "During the past 12 months we have delivered over 300 tech training webinars to more than 5,000 NHS and GP practice teams and our support desk has successfully handled several thousand queries."

The Digital Journey Planner helps GP practice teams assess their use of technology, discover new options, solve issues, and map out a clear 'digital maturity' path to enable their staff and patients to get the most out of digital healthcare technology. Marc comments: "Our Digital Journey Planner platform has been well received by practices, and the bespoke individual development programme we develop for each practice is helping them to develop and improve digital communications with their patient populations and create an informed patient journey."

In Summer 2020 Redmoor expanded into the digital devices sector, joining forces with US-based Eko Health as the UK's sole distributor of Eko digital stethoscopes and telehealth software, which help clinical teams to provide remote care during the pandemic - they have proved particularly effective in supporting care homes, housebound patients and clinical supervision. Marc reports that the use of new tech like digital stethoscopes and ECGs in the UK is phenomenal, and at-home and residential care assessments have improved with digital monitoring.

In the AI sector, Redmoor's chatbot enabling patients to receive real-time information on cancer screening was developed in partnership with Lancashire University and the North Staffordshire Breast Screening team, drawing on tech expertise and health knowledge and experience from the screening teams.

Redmoor provides intensive support for NHS healthcare leaders across England to deliver local sustainability and transformation plans (STPs): this deep dive programme covers work on various technology-enabled care programmes. In London, the company has provided support for digital change managers; and in Northwest England Redmoor developed digital video consultation training programmes for care home teams, connecting them with GP practices throughout the pandemic.

"We were able to offer a remote package of support which was safer for both residents and practice teams," says Schmid. "This included the provision of remote monitoring equipment such as digital stethoscopes, BP machines and pulse oximeters, plus the provision of mobile devices to help care home residents keep in touch with family and friends and lessen their sense of isolation and loneliness. Another successful workstream is our digital nurse upskilling programme."

Looking beyond the post-COVID recovery period, Redmoor believe remote technology-enabled care models will develop and be increasingly perceived as vital enablers to improve patient outcomes, and tackle NHS staff retention. Schmid predicts there will be a system-wide determination to ensure that 'virtual' remains a routine part of care provision, adding that Redmoor Health and Redmoor-ELC Partnership plans include developing the company's TEC offerings to other aspects of care and extending its support to European clinicians.

Visit our website for more information about Video Group Clinics and our approach to technology-enabled care solutions.

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Technology-enabled care is here to stay | Health Europa

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Redmoor Health is a digital health support company with a mission: to maximise the benefits of technology-enabled care (TEC) for patients and clinicians. As passionate advocates of 'digital first', this approach drives Redmoor's commitment to continuously invest in health technology services, in order to support clinicians on the frontline of health and social care.

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Salivary gland cells could play a role in transmission of coronavirus to the lungs or digestive system via saliva, research suggests.

Scientists have shown that Sars-CoV-2, the virus that causes Covid-19, can infect specific cells in the salivary gland in the mouth.

The study also discovered that live cells from the mouth were found in saliva, and the virus was able to reproduce within these infected cells.

Researchers say the findings could help explain some of the oral symptoms experienced by Covid-19 patients, including taste loss, dry mouth and blistering.

Previous studies have shown that cells in the nose and lung contain high levels of RNA for key proteins that allow coronavirus to enter cells.

However, the role of the mouth in transmission is poorly understood, and while it is known that saliva of people with Covid-19 can contain Sars-CoV-2, it has been unclear if mouth cells are involved.

Researchers first studied mouth tissue samples from healthy volunteers to look for individual cells that expressed two key entry proteins - ACE2 and the TMPRSS2 protease - which the virus uses to infect human cells.

They found that salivary gland ductal cells and some gingival, or gum, cells expressed both proteins, showing these cells were vulnerable to infection.

Next they investigated mouth tissues from Covid-19 patients who had died or had given biopsy samples.

Researchers found coronavirus RNA in salivary gland cells, indicating these cells had been infected and found evidence that the virus was replicating in some of these cells.

Professor Kevin Byrd, joint lead author on the study and a co-ordinator of the Human Cell Atlas (HCA) Oral & Craniofacial Biological Network, carried out the work at the Adams School of Dentistry at the University of North Carolina at Chapel Hill.

He said: "Taken together, the study's findings suggest that the mouth, via infected oral cells, plays a bigger role in Sars-CoV-2 infection than previously thought.

"When infected saliva is swallowed or tiny particles of it are inhaled, we think it can potentially transmit Sars-CoV-2 further into our throats, our lungs, or even our guts."

The study, published in Nature Medicine, also discovered that saliva from people with mild or asymptomatic Covid-19 contained mouth cells carrying coronavirus RNA and RNA for the entry proteins.

When saliva from eight of the asymptomatic people was added to monkey cells grown in dishes, some of these cells became infected.

Researchers say this raises the possibility that even people without symptoms might transmit infectious virus to others through saliva.

The study was conducted by researchers from the Wellcome Sanger Institute, National Institutes of Health and the University of North Carolina at Chapel Hill, and their collaborators at the HCA Oral & Craniofacial Biological Network.

The network is part of the international HCA consortium effort to map every cell type in the human body, transforming understanding of health, infection and disease.

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Salivary gland cells could play a role in transmission of coronavirus - study

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Salivary gland cells could play a role in transmission of coronavirus to the lungs or digestive system via saliva, research suggests. Scientists have shown that Sars-CoV-2, the virus that causes Covid-19, can infect specific cells in the salivary gland in the mouth.

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This article discusses the HSEs recent three phase plan and highlights the delay in the return of cancer services.

Why is this interesting?

As the pandemic has already had a huge impact on the diagnosis and treatment of cancer, any further delays post-covid will continue to have a detrimental effect.

Liz Yeates of the Marie Keating Foundation says that early detection and early intervention can have a “significant impact” on a cancer patient’s outcome and the HSE need to better communicate the details of the plan.

A director of  the Irish Cancer Society, Rachel Morrogh says that delays to diagnosis and treatment can lead to reduced survival rates for patients.

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It is "deeply worrying" that cancer services will not be fully restored before the end of this year, the chief executive of the Marie Keating Foundation has said.

The coronavirus pandemic has already had a "hugely negative" impact on the diagnosis and treatment of cancer, and further delays to restoring a full service will result in poorer outcomes for patients, chief executive Liz Yeates said.

The Health Service Executive's three-phase plan warns that commitments to resume non-Covid services are "conditional on there being no further major surges and full implementation of the vaccination programme". Ms Yeates said this "level of uncertainty" regarding the resumption of services could undermine the public's confidence in coming forward when they notice changes in their bodies.

The Marie Keating Foundation is looking for clarity on the details of the HSE's plan so it can "better understand and help communicate it" to the patients it supports.

Screening for breast, cervical and bowel cancers is expected to increase to 90 per cent capacity in June and to 100 per cent from October, according to the plan. Early detection and early intervention can have a "significant impact" on a cancer patient's outcome, Ms Yeates warned.

"It is crucial that, even in these stressful and trying circumstances, the HSE and the Minister of Health recognise that investment and resources are needed to keep our cancer services running safely during the ongoing pandemic," she added.

A director of the Irish Cancer Society, meanwhile, said the organisation is "very concerned" that there will not be a full resumption of cancer services before the end of the year.

Director of advocacy for the charity, Rachel Morrogh, said delays to diagnosis and treatment can lead to reduced survival rates for patients.

Prior to the pandemic, capacity across the cancer system was "insufficient", and waiting lists acted as a barrier to timely care, she said.

"The Irish Cancer Society does not want to return to these 'normal' levels," she said. It is "essential" that capacity is expanded and more healthcare workers are recruited so cancer services no longer have to compete for the same resources.

"We are particularly concerned that delays for radiology, endoscopy and surgical services, as well as other vital cancer services, will continue for a considerable period of time," Ms Morrogh added.

The news of the long period of delay will worry cancer patients who have already faced huge additional challenges over the past 12 months, she said.

The return of healthcare services is projected to take place in three phases: March to June; July to September; and October to December. While the plan says cancer services should be restored by the end of 2021, this is "assuming no significant disruption due to planned delivery, public health restrictions removed or eased, and no adverse winter months impact on acute hospitals".

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Delay in full return of cancer services 'deeply worrying'

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It is "deeply worrying" that cancer services will not be fully restored before the end of this year, the chief executive of the Marie Keating Foundation has said. The coronavirus pandemic has already had a "hugely negative" impact on the diagnosis and treatment of cancer, and further delays to restoring a full service will result in poorer outcomes for patients, chief executive Liz Yeates said.

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This article describes the lasting effects that lockdown will have our nations mental health. Looking at the factors that are inducing stress in people and the limited options for coping mechanisms, it paints a bleak picture.

The article is interesting because it explains the problem on a chemical level, describing the stress hormones associated with these negative feelings.

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With millions of people worldwide now vaccinated, and the summer approaching, it seems like there's light at the end of the long, dark tunnel that is the Covid-19 pandemic and associated lockdowns.

However, while any cause for hope and optimism is to be embraced and celebrated, the end of lockdown doesn't mean the end of problems. Far from it. As well as the economic fallout and various social upheavals we've all gone through, many are grimly certain that we're going to be seeing a significant increase in mental health problems over the coming years. Some are even calling it an imminent "second pandemic".

Not exactly good news admittedly, but it makes sense. A whole year (or more) of lockdown! Of being denied nearly all the pastimes and experiences we enjoy. Of being unable meet friends or family. Of having so little control over our own lives. Of any journey out of the house being inherently risky.

Even if you haven't experienced the pain of losing someone to the virus, how could all that not cause your mental health to suffer?

But while many, perhaps most people, have little trouble accepting the premise, far fewer people ever stop to consider why. Why do periods of stress, strife and trauma do such harm to our mental health? What's going on in our heads to make this outcome so common?

A big part of this is down to how our brains (and bodies) work at the fundamental levels. And a key factor in all this is the effect of stress.

We all know stress. We've all experienced it. It's just a part of life, right? Technically, yes. For instance, our complex modern world is full of all manner of things for our brains to perceive, experience and process, and the many different parts of our brains react in different ways. One fundamental and very influential part is the threat detection system, which essentially monitors everything that's going on in our brain and flags up anything, anything, that might lead to a negative outcome, and tags it as a threat to be wary of.

'Threats'

Unfortunately, our powerful brains can recognise a lot of things as "threats". Whereas simpler creatures usually only perceive a threat if it's something right in front of them, often something with sharp teeth or talons, we humans have the dubious honour of being able to recognise all manner of hazards, even totally abstract ones.

What if the economy declines and I lose my job?
What if I end up in a relationship with someone who's allergic to dogs?
What if they make me sing karaoke at the party?
What if I'm not married before I'm 35?
What if I'm late for my flight?

And so on. All these things, and countless other common causes for concern, present no physical danger to us at all. And they may never happen. Doesn't matter, our brain worries about them anyway.

And worry leads to stress.

Stress is basically what happens whenever we're presented with something to worry about. It's a precursor to the full-blown fight-or-flight response (or fight, flight, or freeze response, to make it more scientifically accurate). If you think of the fight-or-flight response as the big boss in a video game, stress is the hordes of minions you must get through before you encounter it.

Stress is actually a physiological process, as well as a mental one. You get all usual cognitive effects; the negative emotional aspects, the irritability, the bias towards focussing on bad things over good, and so on. But you also get muscle tension, suppressed immune system, appetite increase, and more.

Cortisol

But all elements of the experience of stress can be pinned on the release of stress chemicals, like cortisol, into the bloodstream, where they interact with important parts of your body and brain, to induce all the stress responses we know and very-much-do-not love.

Here's the problem, though. The human brain has evolved the ability to experience long-term chronic stress. When you can be stressed about intangible things that may never happen, those things don't really "go away" ever. Therefore, there's no obvious point where we should stop stressing about them.

Unfortunately, our brains haven't evolved to deal with long-term stress very well. It has finite resources for doing so. And the harder our brain has to work to alleviate the impact of stress, the less time and resources it has to dedicate to maintaining itself and its crucial system, things which are integral for good functioning and our wellbeing.

This is why stress can be, and often is, a key factor in the development of mental health problems. Stress can exhaust the mood-regulating brain cells, leading to the onset of depression. Stress can overstimulate key parts of the brain's aforementioned threat detection system, leading to an excess of illogical, unnecessary fear, what we recognise as anxiety. Attempts to alleviate or prevent the experience of stress can compel us to "self-medicate", in ways which readily lead to addiction. And so on.

Mentally unwell

And just how much a brain has to offer when it comes to dealing with stress depends on what it's gone through already. This is why clinicians often refer to the Stress-Vulnerability model of mental health, which shows that how much stress you're able to deal with determines how much stress it takes to push you over the line into mentally unwell.

Usually, your average person experiences stress, but has many options for reducing it too. Recreational activities and entertainments, social interactions, alone time, travel, sports and exercise, getting help from family and friends, and so on. All these are tried and tested means of reducing stress.

All these things are also unavailable during a lockdown. A lockdown that's due to the literal deadly pathogen raging through our communities.

Basically, the lockdown means that pretty much everyone is experiencing more stress than ever, while having little to no means of reducing it. And stress is a key factor in the development of mental health problems.

That's why we're expecting a surge in mental health problems worldwide, even after the lockdown and pandemic are over.

Because unfortunately, that's just how our brains work.
- Dr Dean Burnett's new book is Psycho-Logical: Why Mental Health Goes Wrong, and How To Make Sense Of It.

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The mental health problems waiting at the end of Covid-19

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With millions of people worldwide now vaccinated, and the summer approaching, it seems like there's light at the end of the long, dark tunnel that is the Covid-19 pandemic and associated lockdowns. However, while any cause for hope and optimism is to be embraced and celebrated, the end of lockdown doesn't mean the end of problems. Far from it.

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What is this article about?
This article highlights the possible changes in improving the delivery of healthcare in Ireland. The article lists out the additional financial investment in areas such as home-support hours and care beds. As well as the main challenges the system is facing such as the long waiting lists for scheduled care in hospitals is acknowledged by the HSE, especially mental health services for both children and adults.
Why is this interesting?
It is interesting to see how the HSE new plans for healthcare is changing its approach and goals during the pandemic. The news also shows that "the plan emphasise on a whole-system reform to be critical". This reform can change a lot in terms of the access in healthcare, efficiency and the care quality people will be receiving due to this new healthcare plan.

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Unprecedented funding allocated this year by Government will provide a once-in-a-generation opportunity to change how healthcare is delivered in Ireland, according to the Health Service Executive.

An additional €3.5 billion is to be set aside for the health service for 2021, a 21 per cent increase on the amount provided originally to the HSE for last year prior to the Covid-19 pandemic. Overall, the organisation is to receive €20.6 billion this year.

It said on Wednesday that the new service plan for 2021 will mean 1,146 additional acute hospital beds provided by the end of the year as well as 66 more critical care beds, bringing the total for adults to 321.

The HSE said the new plan provided for additional spending to improve many services including those in the areas of cancer, maternity and mental health.

It said it would allow for an addition of 16,000 staff above the number employed at the end of 2019 including more than 1,100 medical and dental staff, in excess of 3,500 nurses and midwives and 4,000 health and social care professionals.

HSE chairman Ciarán Devane said the organisation now, for the first time, had "the financial means to bring the [Sláintecare health reform] plans to life".

Within the additional allocation of €3.5 billion, some €1.68 billion is being earmarked for spending on Covid-19 requirements while €1.8 billion will go on non-Covid areas.

" [A total of] €1.1 billion of this additional investment is to deliver permanent and enduring improvements in healthcare arising from the Sláintecare reform programme. The remaining €0.7 billion of this underlying [ie non-Covid] increase is to cover the increased costs of providing existing levels of service which have increased due to demographic changes and various cost increases."

The plan states that this year the HSE will "commence, at scale, the implementation of service reform that have been planned for many years. This will involve a demonstrable shift in the provision of care from hospital to community settings . . . to improve access across the board and expanding services that support people to remain at home."

The plan says services in the community will be strengthened. It says five million additional home-support hours and an additional 1,250 rehabilitation and transitional care beds will be provided. It says 22,500 people will be supported through the Fair Deal nursing home scheme.

The plan also sets out that there will be 28 additional beds provided to enable acute mental health services to respond to Covid-19 and increasing demand.

'Drug companies paid €2.4bn'

The plan also emphasises that whole-system reform will be critical.

It says challenges facing the system include waiting lists for scheduled care in hospital and long waits in emergency departments, particularly for older people and those who have more complex needs.

"There are also difficulties for hospitals that are running with very high occupancy levels . . . waiting times for mental health services for children and adults and long waits for community-based services such as therapies also pose challenges. There is not enough home-based support and a lack of person-centred and responsive support for people with disabilities and their families."

The service plan reveals that the cost of the current deal to access capacity in private hospitals during the current surge in Covid-19 cases is costing €47 million per month.

It also says that the HSE will have "limited capacity" within its plan to respond in 2021 to further pay or other pressures, beyond those which have already been provided for.

"In the event that additional unfunded pressures emerge, for example, via the industrial relations machinery of the State, regulatory processes, Government decisions or the courts etc, the HSE will engage with the Department of Health as to how to proceed."

It says the HSE's capacity to respond to new drugs and new indications for existing drugs is "finite" in that it has a budget in this area of €50 million for the year. The organisation says that needs "to be looked at in the context of the circa €2.4 billion the HSE is already paying each year to drug companies".

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HSE flags golden opportunity to change how healthcare delivered

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Unprecedented funding allocated this year by Government will provide a once-in-a-generation opportunity to change how healthcare is delivered in Ireland, according to the Health Service Executive. An additional €3.5 billion is to be set aside for the health service for 2021, a 21 per cent increase on the amount provided originally to the HSE for last year prior to the Covid-19 pandemic.

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What is this article about?
Cancer services might not be fully restored before the end of this year.
Why is this article interesting?
The pandemic has had a negative impact on the diagnosis and treatment of cancer and there have been delays in services and treatments. The Marie Keating Foundation is looking for clarity on the HSE's plan to fully restore services for cancer patients. Delays in diagnosis and treatment can lead to reduced survival rates for patients

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It is "deeply worrying" that cancer services will not be fully restored before the end of this year, the chief executive of the Marie Keating Foundation has said.

The coronavirus pandemic has already had a "hugely negative" impact on the diagnosis and treatment of cancer, and further delays to restoring a full service will result in poorer outcomes for patients, chief executive Liz Yeates said.

The Health Service Executive's three-phase plan warns that commitments to resume non-Covid services are "conditional on there being no further major surges and full implementation of the vaccination programme". Ms Yeates said this "level of uncertainty" regarding the resumption of services could undermine the public's confidence in coming forward when they notice changes in their bodies.

The Marie Keating Foundation is looking for clarity on the details of the HSE's plan so it can "better understand and help communicate it" to the patients it supports.

Screening for breast, cervical and bowel cancers is expected to increase to 90 per cent capacity in June and to 100 per cent from October, according to the plan. Early detection and early intervention can have a "significant impact" on a cancer patient's outcome, Ms Yeates warned.

"It is crucial that, even in these stressful and trying circumstances, the HSE and the Minister of Health recognise that investment and resources are needed to keep our cancer services running safely during the ongoing pandemic," she added.

A director of the Irish Cancer Society, meanwhile, said the organisation is "very concerned" that there will not be a full resumption of cancer services before the end of the year.

Director of advocacy for the charity, Rachel Morrogh, said delays to diagnosis and treatment can lead to reduced survival rates for patients.

Prior to the pandemic, capacity across the cancer system was "insufficient", and waiting lists acted as a barrier to timely care, she said.

"The Irish Cancer Society does not want to return to these 'normal' levels," she said. It is "essential" that capacity is expanded and more healthcare workers are recruited so cancer services no longer have to compete for the same resources.

"We are particularly concerned that delays for radiology, endoscopy and surgical services, as well as other vital cancer services, will continue for a considerable period of time," Ms Morrogh added.

The news of the long period of delay will worry cancer patients who have already faced huge additional challenges over the past 12 months, she said.

The return of healthcare services is projected to take place in three phases: March to June; July to September; and October to December. While the plan says cancer services should be restored by the end of 2021, this is "assuming no significant disruption due to planned delivery, public health restrictions removed or eased, and no adverse winter months impact on acute hospitals".

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Delay in full return of cancer services 'deeply worrying'

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It is "deeply worrying" that cancer services will not be fully restored before the end of this year, the chief executive of the Marie Keating Foundation has said. The coronavirus pandemic has already had a "hugely negative" impact on the diagnosis and treatment of cancer, and further delays to restoring a full service will result in poorer outcomes for patients, chief executive Liz Yeates said.

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Sláintecare more relevant in post-Covid-19 world than ever before

I found this article interesting as it highlights how the response of the health service to the global pandemic has incorporated the core values of Slaintecare.
Access to healthcare services is based on need rather than ability to pay.
The patients needs are central to the operation of the service.  The patient now moves 'relatively seamlessly through the system' and all availabel resources are utilised. Changes that otherwise would have taken years to implement happened overnight. Inter and intra-hospital co-operation is mandated not optional. The private system, is now leveraged to enable the public system, rather than the other way around.

The health service response to Covid-19 has embedded Sláintecare’s core principles of community and patient-centredness, 'Citizens are getting the right care, in the right place, at the right time, delivered with empathy, equity and efficiency using the best technology.'
Irish citizens should not accept a return to the old ways.

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All over Ireland in recent weeks, people like me who work in the health service have experienced a strange sensation: Overt, unabashed pride in the service we are delivering, echoed by warm public reaction and approving commentary.

Responding to a global pandemic is not the circumstances in which we would have wished this situation to arise, yet like so much in recent weeks it has been thrust upon us.

While we exist still in a maelstrom of so much death, suffering and pain it is nigh on impossible to fully reflect on what is afoot here, yet we owe it to one another and to the future, to try to understand what is going on under the bonnet.

Certain things which now seem self-evident, and maybe always were, have defined the response of the health service to the current challenge.

In our public hospitals, the speed with which you are treated now depends only on your need rather than your ability to pay

The first has been widespread, enthusiastic acceptance that the needs of the citizen in their time of illness are central to the operation of the service and that all available resources must be mobilised to service that end. The patient now moves relatively seamlessly through the system.

Rather than being considered a form of bijou temporary accommodation, trolleys are now used for the far higher purpose of ferrying patients to cohorted wards where they are now cared for by doctors and nurses proficient in the disease they have come in.

No longer do patients have to navigate the labyrinthine system of on-call teams, speciality teams, consultations and professional courtesy, or discourtesy that stands between them and timely diagnosis and treatment, which after all is what they came for.

Telemedicine and remote clinics that otherwise would have been discussed and piloted to death for years just happened overnight, everywhere. Inter and intra-hospital co-operation is mandated rather than an optional extra.

Meetings that should have been emails are now just emails. Paper in general, is considered, well, all a bit 2019. Important diagnostics are being done in the community using all the sinews of the service.

Work is no longer duplicated or triplicated in our emergency departments, where senior decision makers of all specialities are more proximate.

In our public hospitals, the speed with which you are treated now depends only on your need rather than your ability to pay. The private system, for its part, is now leveraged to enable the public system, rather than the inverse.

We have belatedly realised that healthcare workers are useful and good people, in demand the world over, who will stay here and serve us if we just treat them with a bit of humanity.

Those four letters G, D, P and R are no longer accepted as the antidote of choice to doing the right thing when you're not sure if you really want to do it.

What awaits the health service on the far side of this crisis is not pretty. Chronic disease and early cancer is perfectly happy to work from home during the lockdown, safely hidden away from scans and scopes and the prying eyes of specialist teams. Astronomical waiting lists will become intergalactic ones.

Any success our health service has had in recent weeks has come from embedding Sláintecare's core principles of community and patient-centredness

The poverty, unemployment, despair and all their attendant miseries of physical and mental health that we became so familiar with in the last recession will return.

Our already depleted corps of healthcare workers will be physically, mentally and emotionally exhausted to a degree to which some will never fully recover. The healthcare spending hawks of the commentariat so uncharacteristically quiet now are doubtless sharpening their quills.

Business as usual will not be an option.

Students of the project will no doubt recognise that any success our health service has had in recent weeks has come from embedding Sláintecare's core principles of community and patient-centredness.

Citizens are getting the right care, in the right place, at the right time, delivered with empathy, equity and efficiency using the best technology.

The people have spoken and while parts of this compromise plan need finessing, there should be no going back

Sláintecare is more relevant in a post-Covid world than ever before. Calls to abandon it from those who are spooked by one or more provisions in the plan are well-intentioned but wrong-headed and opportunistic.

The Irish people will no longer accept the old ways, nor should they. Everyone should have a say, but no group or interest has the right to tell them what healthcare they can and can't have.

In one of the most divisive elections in our history the one area of violent agreement came in the healthcare debate when all parties united in their commitment to Sláintecare. The people have spoken and while parts of this compromise plan need finessing, there should be no going back.

When I go home from work these days I no longer think of what I might do with the rest of my day, but I am just overcome by a lovely sense of relief that we have one more day behind us and we are still afloat.

And as the evenings lengthen we can allow ourselves to dream of how we might shape the legacy of these times once we prevail. And we will prevail. We must win the peace too.
Anthony O'Connor is a consultant gastroenterologist at Tallaght University Hospital and a member of the Sláintecare advisory council

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Sláintecare more relevant in post-Covid-19 world than ever before

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All over Ireland in recent weeks, people like me who work in the health service have experienced a strange sensation: Overt, unabashed pride in the service we are delivering, echoed by warm public reaction and approving commentary.

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This article raises interesting points about the stigma surrounding HIV and the care available to people in the part of the world where it is most common. The article examines how wealth impacts the patients experience and opportunities. The article goes beyond the HIV specific, and discusses "good death", and how best to offer patients care and dignity in their death. It raises questions about euthanasia as well as patient centredness in the broader sense.

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Thembi Nkambule has been there for hundreds of people dying from Aids in Eswatini - a country where one in four people have HIV. These are the lessons she has learned on what it means to have "a good death".

Thembi sees three kinds of death.

The first is the most common. The person looks at her with blank eyes that say, "It's over. I've given up." Thembi watches as they close their eyes and let go. A life lived in secrecy ending in shame. This is a bad death.

"Then there is the second type," Thembi says. "The person has a message, or sometimes a warning, for the people they will leave behind. There is a lesson they have learned that they want passed on."

The third is the best type of death; it's a good death. The person is about to die knowing that they will leave their family and community in proper order with all conflicts resolved. This type of death doesn't need Thembi's presence, although for anyone with the illness, she is often there for those final moments.

The illness is Aids and Thembi lives in a rural homestead - chickens clucking in the vast fields outside her home - in the kingdom of Eswatini in southern Africa.

The country - previously known as Swaziland - is what the World Health Organization calls "the epicentre of the global HIV and Aids epidemic" - an epidemic experts say is worsening as a result of Covid.

While significant strides have been made with the country's handling of the virus in the past few decades, the country of 1.3 million people still has the world's highest prevalence rate of HIV, estimated at 26%.

But it was far worse a couple of decades ago.

"Death was all around us then," Thembi says.

She remembers clearly when she first heard of HIV. It was the mid-90s and she was a newly-married mother studying for her bachelor's degree in humanities at the University of Swaziland. There had been a drive to encourage blood donation in the country. Many of Thembi's friends donated, but weeks later they dropped out of university, never to return.

"There were rumours going around that their blood had been found to be contaminated with a deadly disease," she says. "Nothing was confirmed by the government or authorities, but the rumours were that when you got this illness, there was no hope, you just died."

Fear gripped the campus, and Thembi and several of her other friends didn't volunteer to donate blood themselves.

"We thought, if we didn't give blood and get told that we too had contaminated blood, we may be safe."

A few years later, when Thembi was working as a teacher at a high school, she began hearing more about HIV. It now seemed to now be affecting large parts of the country's population, including other teachers, her friends, and worryingly, also her students.

She could tell when people became ill, because they suddenly vanished. Locking themselves away out of sight from everyone. Weeks later she would read about their deaths in obituaries in the local paper - though the illness was never mentioned.

But it was now the early 2000s and HIV was being reported about in the press and discussed on the radio. Thembi went to the library and read about the virus, which was infecting people all over the world. It came with universal stigma, she realised.

It was known that the virus could be passed on through sex but some community leaders added their own theories on top. Only those with loose morals, practising depraved and devilish sex were being infected, said some pastors in their church sermons. Thembi knew this couldn't be true, a woman she knew who had only ever been intimate with her husband had just died from it.

Instead of shying away from the "devilish" people she suspected may be ill, who were being shunned by their families and friends, Thembi made an effort to go to their homes and offer them her company.

"Sometimes I would knock on doors and the person wouldn't let me in," she says. "They were too ashamed. But I waited and told them I was here if they wanted me. I wasn't afraid of them."

And then, in 2002, Thembi caught a cough she couldn't shake. At first, as she cared for her young family, she assumed it was a cold. But the cough persisted. One day she had a lightbulb moment.

"Maybe," she thought to herself, "this cough is not going away because it is HIV."

Thembi went to get tested. The results came back positive.

The first few weeks after her diagnosis were a whirlwind of fear.

"How did I get this?" Thembi thought, "What will happen to my three children?"

At the time, antiretroviral drugs for HIV cost $50 a month, a large slice of Thembi's household income.

There was too much to organise, so Thembi did what she had seen too many people shy away from. She told everyone she knew about her HIV status.

"I knew whatever was going to happen to me, I would need help and support from the people I loved," she says. "If I hid away in shame and secrecy I might as well be dead."

She and her husband sat their children down to talk to them about their HIV status. They told them that the illness could not be passed on through a hug or sharing the same bathroom. They said they would be getting treatment, and Thembi explained this was a virus she already knew something about. Since her diagnosis she had discovered a programme called People Living With HIV, which would help guide them through the illness.

Thembi had no idea in 2002, but within a few years she would go on to become the country director of the programme. Her lived experience of the virus meant that people opened up to her.

Thembi was being called to witness the most devastatingly intimate postcards of people's lives with HIV and Aids. A shocked widow who discovered her husband's positive diagnosis letter after his funeral, tucked away in a drawer under their bed, a secret they slept on for years. A woman who had devised a whole plan to help rural communities with the illness, only to fall violently ill and die with it herself, not living to see her dream come to fruition. Fathers leaving behind crying toddler daughters. Sons in shame, asking Thembi if they would be forgiven in the afterlife. Hundreds and hundreds of deaths.

Many sufferers asked Thembi, a fellow HIV-positive citizen of Eswatini, to be there in their final moments of life.

"I take that very seriously," she says, "I can see what they want from me in that moment without them even needing to say anything. Some want me to hold them. Others don't want to be touched but they want someone present. I treat each person as an individual. I give them that dignity."

She wants to give them a good death.

What is a 'good death'?

The concept of a good death has been around for a long time. In 1601 Church of England clergyman Christopher Sutton wrote that dying well involved a deathbed and an audience of loved ones. He noted that a sudden death meant you didn't have time to say goodbye, but a long illness (aside from being painful) made you a burden to others.

It's now a subject for discussion among those providing end-of-life care. According to the US NGO, The National Academy of Medicine, a good death is "free from avoidable distress and suffering for patient, family and caregivers, in general accord with the patient's and family's wishes, and reasonably consistent with clinical, cultural and ethical standards".

If in the West the focus is often on dying with minimal pain, in Africa the emphasis may be placed on how your death will affect the community around you, according to Dr Rabi Ekore. "Individuals... have a sense of obligation to a larger set of other individuals," she writes in The Journal of Palliative Care. So any shame or stigma related to illnesses like HIV is a further barrier to a "good death".

"Today in 2021, far fewer people get HIV or die from Aids in Eswatini than when I was diagnosed," Thembi says, "but already because of the restrictions of Covid, from what I am hearing on the ground, we can expect to see a rise in HIV."

Rose Craigue, Eswatini country director for UNAids, explains that disruption to healthcare programmes in low-income countries - including distribution of contraceptives - is likely to result in seven million unintended pregnancies, according to the UN Population Fund.

"If people are not using protection in an environment where one in every four people is living with HIV, it's logical to assume that Covid is going to increase the prevalence of HIV," she says.

There is also an increase in gender-based violence, including rape, she suggests.

Meanwhile, in November a projection published in the medical journal, The Lancet, said disruption of HIV treatment due to the pandemic could increase HIV mortality by 10% within five years.

Prior to the pandemic Eswatini had made significant progress in the fight against HIV and Aids, Rose Craigue says, "especially in prevention and treatment".

"People no longer have to pay $50 for a month's supply of antiretroviral drugs, it is now less than $1, but there is still a lot of work to do.

"More than half of the population is under the age of 20 and nearly half of the youth are at an exceptionally high risk of HIV infection."

UNAids says that in 2020, young people aged 15-24 accounted for 42% of new HIV infections globally and almost 80% (4 million) of them live in sub-Saharan Africa.

For Thembi, though, people are not statistics, and when she meets someone whose HIV infection has developed into Aids, and whose prognosis is poor, she reminds them of this.

"A good death is peace," says Thembi.

"With HIV and Aids, it is often hard for people to give themselves that peace. To leave this world without regrets," she adds, "I say to them that at the end of the day, life is about finding peace in yourself for the decisions you made in the circumstances you were in.

"Other people will treat you the same as you treat yourself," Thembi says.

"No-one can put shame into you that you do not have yourself. And no-one should feel shame about an illness."

It takes 10 years to train as a surgeon in Ethiopia, but Seida Guadu learned how to carry out emergency operations in just three - she had previously qualified as a nurse. Here she performs a Caesarean section to try to save the lives of a baby and his mother.

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The woman with HIV helping others have a 'good death'

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Thembi Nkambule has been there for hundreds of people dying from Aids in Eswatini - a country where one in four people have HIV. These are the lessons she has learned on what it means to have "a good death". Thembi sees three kinds of death. The first is the most common.

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Why is this article interesting?

This article highlights that people with cancer symptoms have been reluctant to visit their doctor over concerns and worries with becoming infected with COVID-19. Many have waited too long before highlighting their symptoms, resulting in a worse diagnosis than they would have received if they had been sooner.

The article notes that pre-existing flaws in cancer services, including catch-up screenings and long waiting lists, are being exacerbated due the COVID-19 pandemic, causing a great deal of stress on both staff and patients.

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Patients are waiting up to a year to report cancer symptoms due to a reluctance to visit GPs over concerns about becoming infected with coronavirus, a leading cancer doctor has warned.

Dr Sinéad Brennan, a radiation oncologist at St Luke's Hospital in Dublin, said that doctors were seeing patients present with symptoms at much more advanced stages of cancer due to the virus.

She and other doctors have expressed concerns about the impact of the pandemic on cancer treatment and called for urgent action to tackle the disruption in health services from the virus.

Dr Brennan said patients "have had symptoms for much longer by the time they are diagnosed, often going on several months to a year rather than a few weeks or months that we would normally see, and are reluctant to go to their GPs for worrying symptoms of cancer".

She said patients were reluctant to undergo treatment due to perceived infection risk.

'Catch-up screening'

The pandemic had "highlighted pre-existing weaknesses" in cancer services, she said, calling for more resources for "catch-up screening" to reschedule missed or cancelled appointments.

Doctors have raised fears about delays in screening and tests to diagnose cancers with waiting lists lengthening and "increasing exhaustion and worry among staff and patients".

Prof Donal Brennan, a Dublin-based gynaecological oncologist, said that the focus on cancer prevention had been "forgotten", citing the suspension of the HPV vaccination programme. He warned there would be significant waiting lists for non-urgent care "for many years to come".

"Unfortunately, we are seeing some delayed presentation and more advanced disease due to lack of access to diagnostics in the community," he said.

His remarks were released along with comments from other doctors by the Irish Cancer Society ahead of its "Daffodil Day" fundraising event for cancer services on Friday.

Prof Séamus O'Reilly, medical oncologist at Cork University Hospital, said that a "catch-up strategy" was urgently needed to address the missed diagnosis and treatment over the past year.

A "keep-up strategy" was also required to protect future cancer services during the pandemic by properly resourcing "green" or Covid-free care pathways, he said.

'Exhausted'

"Staff are exhausted at the moment and it is also taking a toll on the mental health of cancer patients," he said.

Earlier this week, it emerged cancer services will not be fully resumed until the end of this year under a three-phase plan drawn up by the Health Service Executive for a safe return of services that have been curtailed by the virus.

Taoiseach Micheál Martin told the Dáil that the Government's "safety net arrangement" to use private hospitals during the pandemic would be used to deal with the backlog in non-coronavirus healthcare, including cancer treatment, elective surgeries and outpatient appointments.

Mr Martin conceded that the virus had put pressure on cancer care services. Backlogs in cancer care were being addressed, he said; GP referrals for the first 10 weeks of this year amounted to 110 per cent of last year's levels with referrals in breast, lung and prostate continuing at high levels.

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People waiting up to a year to report cancer symptoms due to Covid-19 fears

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Patients are waiting up to a year to report cancer symptoms due to a reluctance to visit GPs over concerns about becoming infected with coronavirus, a leading cancer doctor has warned. Dr Sinéad Brennan, a radiation oncologist at St Luke's Hospital in Dublin, said that doctors were seeing patients present with symptoms at much more advanced stages of cancer due to the virus.

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This article is interesting because a publicly-run nursing home filled with vulnerable people failed to manage a Covid-19 outbreak. Inspectors found that the quality and safety of residents was “significantly compromised” by inadequate oversight of infection prevention and control practices and procedures. A report from the HSE found non-compliance with health regulations in 23 out of 35 nursing homes, including in the areas of healthcare and infection control.

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A publicly-run nursing home in Co Mayo failed to manage a Covid-19 outbreak and risked spreading the disease to virus-free areas, a report by the State's health watchdog has found.

The Health Information and Quality Authority discovered during an unannounced inspection on October 29th last year that there was just one staff member assigned to cleaning duties at the home during the outbreak at St Augustine's Community Nursing Unit in Ballina.

At the time of the inspection, 22 residents out of a total of 26 living in the home and 26 staff had tested positive for Covid-19 in the outbreak, which was still active when Hiqa inspectors visited.

Inspectors found that the quality and safety of residents was "significantly compromised" by inadequate oversight of infection prevention and control practices and procedures.

The inspection was carried out after concerns were raised about management at the home.

The report into the HSE-run long-term care facility in Co Mayo was one of 35 inspection reports into nursing homes published by Hiqa. The regulator found non-compliance with health regulations in 23 nursing homes, including in the areas of healthcare and infection control.

Inspectors found on the day of the inspection at St Augustine's that the home had been subdivided into two areas, one with infected Covid-19 residents and a Covid-free area.

However, inspectors found that arrangements to ensure no crossover of staff between the two areas were "not effective" and the risk of "Covid-19 cross infection was not controlled."

The facility's front entrance and reception were located in the Covid-19 positive zone but there were no signs to redirect essential visits to the Covid-19 free zone which had a separate entrance.

The Covid area had one staff cleaner, while another staff member had been asked to clean floors in the Covid-free area but there was no cleaner for other areas and equipment in this zone.

"The entire centre and equipment could not be cleaned to the standard required during a Covid-19 outbreak by one person who was redeployed into a cleaning role," the report said.

Hiqa said that there had been no "person in charge" at the centre between August 2020 and October 19th, 2020 - just 10 days before the inspection - and that the lack of a "consistent person in charge" in the weeks leading up to the outbreak contributed to problems discovered at the home.

Non-complaint

The HSE-run nursing home was found to be non-compliant under six regulations, including infection control, healthcare, and governance and management.

"Management systems in place did not ensure that the Covid-19 outbreak in the centre was effectively managed and infection prevention and control in the centre was appropriately monitored," said the Hiqa inspection report.

"Senior management had failed to adequately oversee and support the staff on the ground to ensure the safety of the service during this Covid-19 outbreak."

At another nursing home, Brookvale Manor in Ballyhaunis, Co Mayo, inspectors found on a return visit following an earlier Covid-19 outbreak that the privately run nursing home still had poor contingency plans in place to ensure adequate staffing in the event of a second outbreak.

Hiqa found that during an unannounced inspection on November 9th last the care home, run by private operator Brindley Healthcare, had failed to increase staff numbers in line with their own assessment needs following a previous inspection in June of last year during an outbreak.

At another publicly-run facility, St Joseph's Care Centre in Longford, the HSE's failure to carry out a refurbishment had left "significant non-compliances" with fire safety regulations and that an urgent action plan was required to ensure the safety of 61 residents living at the home.

The latest Hiqa reports reveal details severe Covid-19 outbreaks at some nursing homes.

Glengara Park Nursing Home in Dún Laoghaire experienced an outbreak in late March 2020 the led to 27 residents and 26 staff becoming infected and the deaths of seven residents.

Anam Cara Nursing Home in Glasnevin, Dublin suffered an outbreak in April 2020 where nine residents were hospitalised out of a total of 11 infected residents. The outbreak led to three deaths.

Twenty staff at the home became sick or had to self-isolate due to exposure to the virus.

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Co Mayo nursing home failed to manage Covid-19 outbreak - regulator

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A publicly-run nursing home in Co Mayo failed to manage a Covid-19 outbreak and risked spreading the disease to virus-free areas, a report by the State's health watchdog has found.

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What is this article about?
The National Audit Office commissioned a report which examined the adult social care strategy after Covid arrived.

Why is this article interesting?
It highlights out the governments lack of action and investment in this sector has left a scar on the adult social care industry and thousands of people have been unable to access much needed care. The report also advises that the governments oversight and understanding of adult social care is lacking in many respects.

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The government's failure to get a grip on England's social care crisis left the care system weakened when the pandemic struck and has left thousands of people unable to access the help they need, according to the public spending watchdog.

The National Audit Office (NAO) said Covid-19 had focused attention on social care in England "as never before", highlighting pre-existing shortcomings in services as well as major gaps in the government's understanding and oversight of the care system.

It urged the government to prioritise the setting out of a properly funded plan that would enable the provision of high-quality, sustainable social care for rapidly increasing numbers of vulnerable adults over the next few years.

The NAO report came as Boris Johnson told the Commons liaison committee that social care reforms were in preparation. "Do we need a plan to do it, a long-term plan, a 10-year plan? The answer is yes and the government will be bringing forward our proposals on social care reforms later this year,' he said.

Successive governments have promised and failed to deliver reform of adult social care for years, despite cross-party support. Johnson himself said he had a "clear plan" to do so when he became prime minister in 2019, but has yet to deliver one. Proposals are not expected until an autumn spending review.

The NAO report paints a picture of fragmented services unable to meet the rapidly growing need for care, at risk of staffing shortages, and exposed to constant financial uncertainty, leaving them unable to plan properly or invest in new facilities.

"Despite government's repeated promises it had a clear plan for tackling the social care crisis, today's NAO report shows this is simply not the case. Government has no plan for the workforce, no plan for accommodation, and no long-term vision for social care," said Meg Hillier, chair of the Commons public accounts committee.

The NAO says when lockdown came, the lack of a long-term social care strategy meant the system was weakened by years of funding cuts to local authorities, repeated failure to fix workforce shortages, and a lack of central oversight and understanding of the sector's problems.

It warned that the social care "market" - around 76% of residential care is provided by commercial operators, many of which carry large debt burdens - was fragile, and with bed occupancy down as a result of the pandemic, may need ongoing financial support from the government.

Failure to tackle social care funding gaps meant many adults with care needs no longer received assistance from local authorities. There had been a 6% fall in over-65s receiving council care over the past five years. A quarter of over-65s reported that they needed - but got no help with - daily living activities such as washing and dressing.

At the same time, "too many" adults who needed assistance were reliant on unpaid help from family, neighbours and friends. This informal network of support - there are around 7.3 million carers in England - may become increasingly strained as demand for care rises in future, the NAO says.

Official estimates suggest that at current rates, 57% more over-65s and nearly a third more working-age adults will require care in 2038 compared with 2018, while the annual cost of providing that care is likely to roughly double, to around £57bn.

Social care directors in England said last year thousands of people had lost their lives prematurely because care homes were "ill-equipped and under-resourced" to deal with Covid as a result of years of underinvestment in social care. A cross-party group of MPs called in October for a £7bn-a-year funding boost by 2023.

"The lack of a long-term vision for adult social care coupled with ineffective oversight of the system means people may not get the care that best supports them," said the head of the NAO, Gareth Davies.

Cllr Ian Hudspeth, chair of the Local Government Association's community wellbeing board, said: "As the NAO recognises, short-term funding and ongoing uncertainty has made it difficult for councils, which are already facing significant financial pressures, to plan for care and support services in the long term."

Liz Kendall, Labour's shadow social care minister, said: "The prime minister promised to fix the crisis in social care on the steps of Downing Street in July 2019 - but 18 months later this plan is still nowhere to be seen. The government must bring forward their plans for reforming social care."

A Department of Health and Social Care spokesperson said: "Delivering a care system fit for the future is a top priority and we will bring forward proposals for social care reform later this year.

"We are providing councils with access to £1.5bn in additional funding for social care in 2021-22, on top of a further package of support worth £3bn to support local authorities and help address the additional pressures, including on adult social care, during the pandemic.

"We have just announced a further £341m to support rigorous infection and prevention control measures and rapid testing to keep people safe as we start to cautiously ease lockdown restrictions."
Topics

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Lack of social care strategy left system weakened when Covid struck - report

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The government's failure to get a grip on England's social care crisis left the care system weakened when the pandemic struck and has left thousands of people unable to access the help they need, according to the public spending watchdog.

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Ireland's first mother and baby mental health unit.

Why found this article interesting is that it shows that Ireland is slowly in implementing plans related  to health care. Mother and baby mental units are for mothers  suffering from mental illness.

At the the child's birth, the mother and child would often be separated  due to the mother mental health.  Psychologist have found that separation of mother and child at birth is not good for the child nor mother.  Also   in 2016 an  estimated 40-60% of women stated that they would potentiality benefit from mother and baby mental units hence the plan to make them accessible.

This was since 2017 that the plan was doing to be implemented. This shows that their are lags in implementing plans which seems to be an issue within the Irish healthcare system, and the budget seems to be the common issues as  to why these plans dont fall through. Not finding way to implement this plan will lead to lack of accessibility of the needs of mothers with mental illness.

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Plans underway for Ireland's first mother and baby mental health unit, amid Covid-19 delays

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New and expectant mothers with severe mental health issues are currently admitted to a general psychiatric ward.

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What is this article about?
Irish respiratory physician warns the cases of tuberculosis (TB) are in danger of rising as a result of increased pressure on the healthcare system during the pandemic.
Why interesting?
The article also revealed that Covid -19 restriction leads many people below the poverty line for the first time. Inadequate and overcrowded living conditions, malnutrition, drug and alcohol use, and weakened immune system are all factors associated with an increased risk of acquiring TB. The Irish Thoracic Society is calling on the Government to take decisive action to combat the hidden but very real and devastating health, social and economic impact of TB.

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Cases of tuberculosis (TB) are in danger of rising in the pandemic as resource-starved services struggle, a leading specialist has warned.

espiratory physician Dr Marcus Butler said a number of factors are leading to an increased risk of spreading of the illness.

"Sub-standard and overcrowded living conditions, poor nutrition, drug and alcohol misuse, as well as a weakened immune system due to other illnesses, are all factors associated with increased risk of acquiring TB.

"Covid-19 has worsened these conditions for many, while bringing many more below the poverty line for the first time."

Dr Butler, who is vice president of the Irish Thoracic Society, was speaking ahead of World TB Day on Wednesday.

"The likelihood of rising TB cases as a result of the pandemic comes against the backdrop of increased pressure on health services, reallocation of staffing resources and reduced numbers of people presenting with their symptoms due to Covid-19 restrictions.

"All of these factors are storing up an unprecedented TB crisis for a resource-starved service on top of an already complex and demanding, albeit largely hidden, public health threat."

Around 267 cases of TB were notified here in 2019.

Some 40pc of all TB cases notified were in Irish-born people with 44pc in foreign nationals and the origin of others unknown.

TB remains one of the world's deadliest infectious killers and is the ninth leading cause of death worldwide. Nearly 4,000 people a day lose their lives to TB - approximately 1.5 million annually - and close to 28,000 people fall ill with this preventable and curable disease.

Global efforts to combat TB have saved an estimated 63 million lives since 2000.

With the pandemic now in its second year, it is continuing to divert essential medical resources and attention away from providing life-saving diagnosis, medicine and care to people suffering from TB worldwide.

There is particular concern that drug-resistant and multi-drug-resistant TB pose a significant threat to gains made, making the fight against TB ever more complex and challenging.

The Irish Thoracic Society is calling on the Government to take decisive action to combat the hidden but very real and devastating health, social and economic impact of TB and to bring Ireland in line with our European neighbours in the fight against this preventable disease.

It wants five key actions to be tackled, including the appointment of a national TB controller.

There should also be a national TB screening programme for high-risk groups, investment in contact tracing and surveillance activities, as well as an education and awareness programme for healthcare professionals and the public.

The action plan should follow United Nations recommendations.

This includes fully activating high-level leadership to urgently reduce TB deaths and drive multisectoral action to end TB.

The plan also entails appointing a national TB controller and scaling up the provision of preventive treatment.

Establishing a co-ordinated and resourced national clinical programme encompassing hospital-based clinics, appropriate inpatient facilities, public health and laboratory services would also be on the agenda.

On top of that, the development of the Irish Mycobacteria Reference Laboratory (IMRL) and the National Clinical TB Centre on the St James's Hospital site in Dublin would need to happen without further delay.

Irish Independent

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'TB crisis' looms as pandemic hits living standards and healthcare, specialist warns

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Cases of tuberculosis (TB) are in danger of rising in the pandemic as resource-starved services struggle, a leading specialist has warned. espiratory physician Dr Marcus Butler said a number of factors are leading to an increased risk of spreading of the illness.

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Nearly 1,700 people attend new walk-in Covid test centres
Why is this interesting?

This article is interesting as it shows the HSE is taking some form of action to address symptom-free community transmission of COVID-19.
Around 20% of people who contract the virus show no symptoms; Five free, no-appointment necessary test centres are open for the next seven days in areas where there is a high number of positive cases. This is a change from earlier HSE practice which required symptoms and a referral from a GP to receive a test.

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Close to 1,700 people attended the five new walk-in testing clinics in Dublin and Offaly today.

The new test centres operated by the ambulance service opened in Dublin and Tullamore this morning. The centres will be open for one week and had aimed to test up to 500 people each day.

On the number of people being tested today, HSE public health specialist Dr Miriam Owens said: "That's a very heartening number so hopefully there'll be more tomorrow and over the next number of days."

The HSE is urging those living near a walk-in test centre who do not have symptoms of Covid-19 but who are nevertheless concerned about the virus to drop in for a free test over the next seven days.

Around one in five people have no symptoms but still spread the disease.

This is of particular concern because the highly transmissible B117 variant is dominant and case numbers are rising again.

The Chief Executive of the Health Service Executive has described the contribution of the National Ambulance Service in testing people for Covid-19 as "mighty".

Another 683 cases and 18 further deaths were reported by health officials yesterday.

Pat Mooney from @AmbulanceNAS giving us a little tour of the walk-in swab centre @rtenews pic.twitter.com/AHzrGd5K5n
- Laura Hogan (@LauraHoganTV) March 25, 2021

The new test centres have been set up to actively find asymptotic infections to get a better understanding of how and why the virus is spreading quicker in certain areas.

The five areas are Blanchardstown, Tallaght, Irishtown and Grangegorman in Dublin, and Tullamore in Co Offaly.

They are for people who are 16 and over, have no symptoms, live within 5km of the centres, and have not tested positive in the last six months.

No appointment is necessary.

The HSE said testing people with no symptoms will help to find positive cases of Covid-19 and break the chains of transmission.

Our National Ambulance Service are just mighty. A 24hr paramedic service but also testing in nursing homes,meat plants, pop up swabbing centres. Vaccinating in nursing homes, major centres & housebound. Tomorrow opening 5 "walk in" swabbing centres. #proud @AmbulanceNAS @HSELive
- Paul Reid (@paulreiddublin) March 24, 2021

Read more:
Latest coronavirus stories
'I'd like to know one way or the other' - walk-in test centres proving popular

HSE Director of Public Health for the Midlands Dr Una Fallon has said Tullamore was one of the five locations picked for the walk-in Covid testing because of a "relatively high rate" of infections in Co Offaly.

Speaking on RTÉ's Morning Ireland, she said people are invited to come and get tested at one of the five test centres if for some reason they suspect they could have Covid-19.

She said it is specifically for those who do not have symptoms and who are aged 16 and over. Dr Fallon said people need to bring ID and a valid mobile phone number.

"The purpose is to assess the level of asymptomatic infection in the community", she said.

Busy start at the Grangegorman test centre... over 50 people waiting in line.. moving quickly though... 3 mins to register, 3 mins for the swab, then around 24 hours for the results...@rtenews pic.twitter.com/W9K4N2vqtH
- Conor Hunt (@conorfhunt) March 25, 2021

If a person tests positive having been tested at the walk-in centres, they will be contacted by the contact tracing centres.

She said contact tracing going back 14 days, and asking people about every individual they were in contact with, is not always an efficient way to determine the source of infection.

Dr Fallon said: "For every case that is associated with any complicated setting, they get referred back to us and we take a history that is specific to that setting."

She said the rates in Co Offaly are driven by a few incidents that have to play out.

"We have an outbreak in one particular workplace and we have done a lot of testing in that setting and uncovered a lot of asymptomatic infection and we are doing another round of testing," Dr Fallon said.

She said the HSE believes with another outbreak in the area in a crèche all cases have been detected.

"The numbers are likely to come down once those outbreaks subside," she said, adding that she expects the situation in Offaly to pass.

Dr Fallon appealed to people ahead of the Easter holidays asking "people to have a quiet Easter and to enjoy the outdoors but stay away from other people".
Reporting by George Lee, Laura Hogan

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Nearly 1,700 attend new walk-in Covid test centres

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Close to 1,700 people attended the five new walk-in testing clinics in Dublin and Offaly today. The new test centres operated by the ambulance service opened in Dublin and Tullamore this morning. The centres will be open for one week and had aimed to test up to 500 people each day.

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New HSE plan aims to keep patients out of hospitals and cut numbers in residential care - Irish Times

Why is this interesting?

The HSE’s National Corporate Plan 2021-24 is a very pretty document filled with very aspirational promises. I don’t think this IT article gives nearly enough attention to the feasibility of securing appropriate funding. However, it does highlight the HSE’s newfound determination to improve primary and community based services, as well as reducing waiting times for treatment by increasing capacity (in part by renting beds from private hospitals).

The Corporate Plan points out that Ireland’s rate of unmet medical needs is higher than the EU average (p 24).

It’s good to have a plan, but how effectively will it be implemented?

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The health service will seek to reduce the need for people to attend hospital in the years ahead and reduce the numbers of older people in residential care as part of a new "home first" approach.

The HSE also said it would seek to deliver significant reductions in waiting times for scheduled care as part of a new three-year corporate plan which it released on Tuesday.

It said it would also work to increase capacity by implementing elective-only care centres, purchasing additional capacity from the private sector, funding more hospital beds and using resources more effectively.

The plan also seeks to accelerate the digitisation of health services .

HSE chief executive Paul Reid acknowledged the health service was "far off the mark" in terms of meeting waiting time targets at present. He said the HSE would engage collaboratively with its board, the Minister for Health and the Department of Health on the best use of the €240million 'access to care' fund for this year, as well as the €125million fund provided to the National Treatment Purchase Fund (NTPF) to map out priorities for 2021.

There is no single overall cost set out in the plan for delivering its objectives.

As part of six overall objectives, the plan aims to manage the Covid-19 pandemic while delivering healthcare safely to the public. It says the HSE will "based on risk and clinical need, retain capacity for potential surges in order to meet patient care needs".

The plan also envisages boosting primary and community services and reducing the need for people to attend hospital.

"We will establish 96 community healthcare networks and 32 community specialist teams for older people and chronic disease supporting our 26 hospitals ensuring integrated care is provided locally at the appropriate level of complexity."

"We will expand community diagnostics to improve access for general practice and community specialist teams."

The plan says the HSE will implement an agreement reached with family doctors in 2019 which will provide for a structured programme of chronic disease management in the community for about 430,000 people with medical cards and GP visit cards.

The plan also says "we must reduce the number of older people in residential care settings by providing services to people as close to home as possible which will allow our ageing population to maintain their independence and live well in the community".

The new plan says the HSE will deliver significant reductions in scheduled care waiting times. It says it will aim to make "significant progress towards achieving waiting times outlined within the Sláintecare report; 10 weeks for a new outpatient appointment, 12 weeks for an appointment for a procedure, and 10 days for diagnostics".

"We will work to increase capacity by implementing elective-only care centres, purchasing additional capacity from the private sector, funding more hospital beds and using resources more effectively."

"We will establish dedicated teams at national, regional and hospital levels, to support the effective planning and delivery of the scheduled care reform."

The plan says the HSE will progress the implementation of the new policy on mental health. It says it will prioritise "child and adolescent early intervention, and enhancing early interventions for adult mental health services".

The plan says the HSE will "work to re-imagine disability services, to be the most responsive, person-centred model achievable with greater flexibility and choice for the service user".

The plan says at present the health service "continues to be held back with inefficient, and often paper based patient interactions, with patient presence required due to the lack of tools rather than the patient need".

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New HSE plan aims to keep patients out of hospitals and cut numbers in residential care

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The health service will seek to reduce the need for people to attend hospital in the years ahead and reduce the numbers of older people in residential care as part of a new "home first" approach.

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What we learned from tracking Covid-19 policies in 186 countries

Why is this article interesting?

This article discusses the various approaches taken by different countries in combatting the covid-19 pandemic.  It is most interesting as it highlights the fact that economic wealth does not define the countries’ success in combatting the virus from an international perspective.  This article also draws an interesting conclusion in its observation that countries who, in early stages of the pandemic struggled to control the virus in the initial stages of the pandemic have some of the swiftest vaccination roll-outs (Israel/UK/US)

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By Thomas Hale, University of Oxford
In March 2020, as Covid-19 swept around the globe, my colleagues and I began debating the bewildering new measures popping up around the world with our master's students in a politics of policymaking class at the Blavatnik School of Government at Oxford University.

We had a lot of questions. Why were governments doing different things? Which policies would work? We didn't know. And to answer those questions, we needed comparable information on these new policies, including school closings, stay at home orders, contact tracing and more.

A few weeks later, we launched the Oxford COVID-19 Government Response Tracker to help find these answers. It has now become the largest repository of global evidence relating to pandemic policies. To date, more than 600 data collectors from around the world have helped us track 20 different categories of coronavirus response, including lockdown, health, economic, and now vaccine policies in 186 countries.
From RTÉ Radio 1's This Week, Dr Mike Ryan, Executive Director of the WHO's Health Emergencies Programme on a year of the pandemic
We then group those policies into a number of indices, including the stringency index, which records the number and intensity of closure and containment policies on a scale of zero to 100. 15 countries reached 100 on the stringency index, while seven never surpassed 50. The countries with the highest average stringency were Honduras, Argentina, Libya, Eritrea and Venezuela. Those with the lowest were Nicaragua, Burundi, Belarus, Kiribati and Tanzania.

A year on, what else have we learned about how governments have handled the largest health crisis in memory?

One surprising observation is that similarities can actually outweigh differences. During the first months of the pandemic, governments mostly adopted similar policies, in mostly the same sequence, at mostly the same time - the two middle weeks of March 2020.

Our World in Data, CC BY

This policy convergence contrasts with the uneven spread of Covid-19 around the world. In March 2020, though the disease was already prevalent in some parts of Asia, and rapidly spreading in parts of Europe and North America, it had yet to reach a wide scale of transmission in many parts of the world. The global lockdown rush therefore contrasted with the varying epidemiological situations countries faced. This meant that some countries locked down too late, and others arguably too soon.

But as the pandemic progressed, countries - and, in some parts of the world, states and regions - began to vary considerably.

Our World in Data, CC BY

Best in class

Some governments were able to contain the first wave and then preserve those gains with a mix of targeted closure and containment measures, extensive testing and contact tracing, and firm international border controls.

Places like China, Taiwan, Vietnam and New Zealand all managed not just to flatten the curve but to keep it flat, albeit with a few small flare-ups. In our data, we count 39 countries that have only experienced one wave of disease, though limited testing and reporting systems, or government suppression of information, make it hard to determine the true number.

Other countries have had less success, seeing second, third, or even fourth waves of disease. Some of these have been relatively small outbreaks, controllable with test and trace measures and targeted restrictions. For example, South Korea and Finland, though not able to eliminate the virus, have largely kept it from stressing health systems.
From RTÉ Radio 1's Drivetime, CNN's Korea Correspondent, Paula Hancocks on the contact tracing system in South Korea
Rollercoaster countries

Too many countries have been on a veritable rollercoaster of rising and falling infections with corresponding policy whiplash and tragic death tolls. The United States, United Kingdom, South Africa, Iran, Brazil and France have seen successive waves of disease and have phased in and out of restrictive policies.

Though initially debated, the scientific literature is now clear: Covid-19 restrictions work to break the chain of infection, with timely, sharper restrictions having greater effect than slower, weaker ones.

But while clearly true on average, there is no guarantee this recipe will always work. Countries like Peru suffered rising disease despite restrictive policies, perhaps showing that compliance and trust are also key to effectiveness. Some evidence also suggests that stronger economic support makes Covid-19 restrictions more effective.
From RTÉ Radio 1's Morning Ireland, Martin McKee from the London School of Hygiene and Tropical Medicine on further restrictions in some European countries in a bid to curb rising infection rates.
Money isn't everything

While we can identify patterns of successful response, it is also evident that none of the country characteristics that were expected to provide an advantage before the pandemic, such as wealth or autocracy, have clearly done so.

If you divide the world into countries with above average and below average deaths, robust government responses and weak ones, you will find in both groups plenty of rich countries and poor countries, democracies and dictatorships, those ruled by populists and those governed by technocrats.

Success and failure are moving targets. As the pandemic has evolved, so have government responses. According to our data, vaccines are now available in 128 countries and rising. Notably, some of the countries most swiftly rolling out vaccination - Israel, the UK, the United States, the UAE - are places that have previously struggled to control the virus through restrictions and test-and-trace systems.
From RTÉ One's Six One News, Israel begins reopening economy following vaccination roll-out
Lessons for the future

One year on, the pandemic is by no means over, but already our data suggests some implications and lessons for governments.

First, old ideas about what contributes to pandemic preparedness need to be updated. Some countries with formidable scientific and healthcare capacity stumbled mightily. At the same time, places with less capacity, including Mongolia, Thailand and Senegal have managed to largely keep people healthy and the economy running.

Second, learning from others, or even from past experience, cannot be taken for granted. In March 2020 eastern European countries like the Czech Republic, Hungary, and Bulgaria saw what happened to their western neighbours and imposed restrictions before community transmission became widespread. They largely avoided the death tolls many western European countries experienced in the first wave.
From RTÉ Radio 1's Drivetime, Justin O'Grady from COG-UK and the Quadram Institute on the use of genome sequencing to detect new Covid-19 variants
But then just a few months later some of the same eastern European countries did the exact opposite, waiting too long to reimpose measures as cases rose in the autumn, with all too predictable consequences.

Finally, while our work has tracked individual governments' responses, it is clear that exiting the pandemic will require global cooperation. Until transmission is curtailed throughout the world with restrictions and vaccinations, the risk of new variants sending us back to square one cannot be ignored.

In the first year of the pandemic we saw little cooperation between governments. In the next, we will need to work together to control this disease.

Thomas Hale is Associate Professor in Public Policy at University of Oxford. Noam Angrist, Emily Cameron-Blake, Lucy Dixon, Laura Hallas, Saptarshi Majumdar, Anna Petherick, Toby Phillips, Helen Tatlow, Andrew Wood, and Yuxi Zhang contributed to this article. It is published in collaboration with the International Public Policy Observatory, of which The Conversation is a partner organisation. This piece was originally piublsihed by The Conversation.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ

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What we learned from tracking Covid-19 policies in 186 countries

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By Thomas Hale, University of Oxford In March 2020, as Covid-19 swept around the globe, my colleagues and I began debating the bewildering new measures popping up around the world with our master's students in a politics of policymaking class at the Blavatnik School of Government at Oxford University.

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Week 7

Next generation local health policies will rely on geospatial data (https://www.geospatialworld.net/blogs/next-generation-local-health-policies-will-rely-on-geospatial-data/)

Why is this article interesting?

This article discusses the introduction of data tracking technology in health policy.  This is particularly relevant since the Covid-19 Pandemic.  Technology such as the Covid Tracker App is an example of these geospatial technologies in Ireland.  This tech may be a pathway to real-time health statistics and data to both care providers and the public, however they pose some questions in relation to privacy.

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I found this article very interesting as it is opening up conversation on quite a controversial yet conservative topic. Many doctors are arguing that some terminally ill patients deserve to have the choice for a medically assisted death. This is not something that has ever been legal in Ireland before and appears in a small amount of countries. Many doctors believe it to be morally wrong to insist that people are denied the choice of assisted dying and are forced to live through the pain and suffering at the end of a terminal illness.

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A newly formed group of GPs has proposed introducing new laws to allow medically assisted dying, saying its rollout is possible in a "safe and fair manner".

n a written submission to the Oireachtas justice committee which is considering the Dying with Dignity Bill, the 105-member Irish Doctors supporting Medical Assistance in Dying (IDsMAiD) group says that in certain cases of terminal illness, "patients deserve to have their choice respected".

The bill has been tabled by People Before Profit TD Gino Kenny and is seeking to legalise assisted dying in certain circumstances for patients with terminal illness.

It passed to committee stage in October, following a Dáil vote.

There have been more than 1,000 submissions both supporting and opposing the proposed new laws, according to Mr Kenny.

In the IDsMAiD submission, the doctors state the bill's criteria for qualifying for assisted dying is appropriately "conservative and restrictive" and that the safeguards proposed are "conservative, balanced and fair".

Regulation, monitoring and reporting of assisted dying must take place to ensure accountability and transparency and to foster trust in the public, the group added.

The GPs also argue that "hypothetical fears" that such legislation would harm Irish society are "insufficient reason to condemn people with terminal illness to unnecessary suffering".

Dr Andrew Lyne, a GP based in Tower, Cork, helped draft IDsMAiD's submission.

He said his "guilty conscious awoke" when he became aware of the Dying with Dignity Bill. "Like others in 2013 I followed Marie Fleming's Supreme Court 'right to die' case," he said.

"She was in the final stages of multiple sclerosis and her physical condition had deteriorated so that she was unable to operate her electric wheelchair.

"She was in severe pain, was bed-bound for much of the day and had very limited use of her hands.

"She was unable to access palliative care although the benefits of palliative care would have been very limited.

"Unfortunately for Marie Fleming the law was unflinching and cruel, denying her an escape from her pain and suffering.

"As a citizen I felt angry that my country would treat an individual with so little compassion.

"As a doctor I was ashamed of my profession for the lack of empathy for her predicament."

The GP added that it was his belief that it is "morally wrong" to insist that people are denied the choice of assisted dying and are forced to live through the suffering at the end of a terminal illness.

"We advocate for the introduction of a restrictive provision of medical assistance in dying, confined to adults who have capacity to give consent and have a terminal illness," he said.

"We simply want to offer choice to those who are already dying from the terminal illness."

Sunday Independent

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Doctors' group backs 'right to die' campaign

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A newly formed group of GPs has proposed introducing new laws to allow medically assisted dying, saying its rollout is possible in a "safe and fair manner". n a written submission to the Oireachtas justice committee which is considering the Dying with Dignity Bill, the 105-member Irish Doctors supporting Medical Assistance in Dying (IDsMAiD) group says that in certain cases of terminal illness, "patients deserve to have their choice respected".

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I found this article interesting because it details how health and social care services are being asked to avail of an online course to enable them to apply a "human rights based approach" to their work. This is a result of the care received in nursing homes during the covid-19 pandemic and the rights of residents to visitation from family and loved ones.

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People working in health and social care services are being asked to avail of an online course to enable them to apply "a human rights-based approach" to their work.

The Health Information and Quality Authority (HIQA), which made the announcement this morning, described the approach as central to the development of its national standards.

It comes as Dr Maeve O'Rourke of the Irish Centre for Human Rights at NUIG suggested that an Oireachtas committee examines the establishment of a public inquiry, to investigate the practice of nursing homes during the Covid-19 pandemic.

Dr O'Rourke was among several speakers at a seminar hosted by the UCD School of Social Policy, Social Work and Social Justice in conjunction with the Irish Association of Social Workers (IASW) this morning.

The event explored the rights of nursing home residents and their family members to visitation within the context of Covid-19.

Dr O'Rourke encouraged those attending the webinar, including family members of people in nursing homes, to get legal advice if human rights laws were broken.

She said nursing home residents needed to be at the centre of remedies and structures to protect them from future harm.

Majella Beatty from the advocacy group Care Champions said residents died in the past year without messages of comfort from their families.

She said one home refused to hold the phone up to the ear of a resident who was at the end of life, to allow her family comfort her; because according to Ms Beatty, staff said they did not have time.

Dr Ramona Backhaus of Maastricht University, who has been researching 76 nursing homes in the Netherlands for the past 12-months, outlined the approach there.

While most Dutch nursing homes are not for profit, in the Netherlands, many decisions regarding nursing homes were taken by the government and nursing home organisations.

Dr Backhaus told the webinar that while regulations and restrictions were initially introduced without the voices of residents or of families being heard, things have changed.

After finding that a general ban on visits may do more harm than good, Dutch nursing homes reopened to visitors after two months.

Current Dutch law allows local bans to be applied at nursing homes in "outbreak" situations.

The IASW says the Irish Government has chosen not to support a similar rights-based model to the Netherlands.

Yesterday the IASW met Minister for Older People Mary Butler to express concern about "unreasonable visiting refusals" by some nursing homes.

Under new guidance, residents can receive two visits per week where most of the staff and residents are vaccinated.

It also was noted at this morning's event that safeguarding legislation to protect those who may be at risk or harm of abuse, has not been published.

At yesterday's Joint Oireachtas Committee on Health, Sinn Féin's David Cullinane put it to the Assistant Secretary of the Department of Health's Social Care division that HIQA had been calling for changes to legislation since 2007.

He pointed out that it is now 2021.

Dr Kathleen MacLellan said the Department was in the process of "finalising" and will be "going to consultation soon" on a safeguarding policy which will underpin any legislative requirements needed for safeguarding teams or for others in the management and assessment of abuse or neglect.

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New initiative over rights of nursing home residents

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People working in health and social care services are being asked to avail of an online course to enable them to apply "a human rights-based approach" to their work. The Health Information and Quality Authority (HIQA), which made the announcement this morning, described the approach as central to the development of its national standards.

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Why is this interesting?

There was a stand off between Gards and the CMH after they refused to let a man in even though the court had ordered for him to be taken there for treatment. The CMH said that they had no beds and there are usually 20 to 30 individuals on a waiting list.

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Gardaí in three-hour standoff with staff at gates of Central Mental Hospital

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Gardaí engaged in a three-hour standoff at the gates of the Central Mental Hospital (CMH) last week when staff refused to admit a severely mentally ill man following a court order that he be taken there for treatment.

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Why interesting
This article has highlighted how corvid 19 has been a catalyst in encouraging remote health care solutions. It has encouraged innovate ways of decreasing numbers in hospitals and doctors waiting rooms.

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Med-Tech Innovation | Latest news for the medical device industry

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Valerie Phillips, healthcare expert, and Simon Bates, life sciences expert, at PA Consulting, evaluate the trends triggered by COVID-19 that are likely to continue this year.
COVID-19 is uncontestably the greatest challenge healthcare organisations across the globe have faced in recent history. Resources have been redeployed systemwide to respond to the pandemic, while a backlog for non-COVID-19 care continues to grow steadily. The British Medical Association highlighted the scale of the problem; in the period between April and November 2020, there were 2.57 million less elective procedures and 18 million less outpatient attendances. The waiting list for consultant-led referral to treatment stands at 4.46 million patients.

However, in parallel, COVID-19 is acting as a transformation catalyst, accelerating the implementation and adoption of change in healthcare delivery at an unprecedented scale. New models of care, using remote healthcare solutions and digital technologies, are emerging across the care continuum and are likely to remain in place after the crisis phase has passed.
Virtual patient consultations are now widespread
According to the NHS, in the four weeks preceding 12th April 2020, over 70% of routine GP consultations were delivered remotely, and 26% face-to-face. In the same period 12 months previously, only 25% were remote. All secondary care providers and 95% of practices now have video consultation capability. The British Medical Journal notes that the scope of video consultation is wide, particularly for the management of long-term conditions, including diabetes, hypertension, asthma, stroke, psychiatric illnesses, cancers, and chronic pain. Virtual consultations reduce patient flow through healthcare facilities and limit infectious exposures, but more importantly, they facilitate and broaden access to healthcare. There is unlikely to be a return to pre-pandemic levels of in-person patient consultations.
Digital monitoring solutions and self-care will continue to increase
Patient self-monitoring in the home setting has been accelerated to promote distancing and to release resources for COVID-19 care. Looking beyond the crisis, these solutions offer a range of benefits, especially to those living with long term conditions. Wearables, such as heart rate sensors, exercise trackers, sweat meters and oximeters, provide real-time information to patients, enabling self-care. Patients are engaged and empowered to manage their own care; it reduces the need to visit bricks and mortar clinical settings, cases can be triaged, resources are directed where the need is greatest and clinician work experience is improved. Moreover, increased self-management of long-term chronic conditions has the potential to have a significant impact on health budgets. According to NHSE, long-term conditions account for 70% of total health and care spend. Self-monitoring will continue past the COVID-19 crisis, with the global wearable medical device market expected to witness a CAGR of 27.9% over the period to 2027.
Connected Devices and the IoMT will enable transformation of care delivery at disease-level
The IoMT goes beyond patient self-monitoring. It is a connected infrastructure of medical devices, software applications, and health systems and services. This facilitates personalised treatments at scale and embraces the end-to-end patient journey, extending beyond episodes of care. Several factors are driving the expansion of this market; the evolution of high-speed networking technologies, the increasing penetration of smartphones, tablets, and other mobile platforms and, most importantly, patients' acceptance of remote care and their increased use of connected medical devices. It is expected that there will be further integration of medical devices, patient records, health systems and platforms to deliver the anticipated benefits and outcomes. Medtech innovators are responding in two key ways. Firstly, they seek to understand the impact their device will have across the care pathway and so have started to formulate propositions which go beyond product features and benefits. Secondly, they recognise that these connected devices are in the hands of patients and are increasingly incorporating consumer design principles into the development of their products from the outset, focusing on convenience, experience, and personalisation.
Diagnostics will continue to play an integral role in healthcare
For many years, diagnostics has been in the shadow of treatment. In 2020, because of COVID-19, diagnostics took centre stage. Accurate detection and timely interventions, such as self-isolation, emerged as a pressing need. Diagnostics has the power to deliver far beyond the current pandemic; they play a vital role in screening, preventing and monitoring disease, as well as informing prognosis, enabling targeted treatments and determining outcomes. Diagnostics will continue to play a pivotal role in disease management beyond COVID-19 and the market is expected to grow significantly. Market And Markets forecasts that the IVD market alone will grow to $96 billion by 2025. COVID-19 has demonstrated the demand for low cost, point of care, consumer-friendly diagnostic tests, where there is expected to be an increased focus on innovation in 2021 and beyond.
Looking beyond 2021
COVID-19 has demonstrated how healthcare systems can rapidly deploy new technologies and care models, with internet-first and home services at scale at the forefront. It's clear there can be no return to the previous status quo. This system-wide desire for change represents an opportunity for medtech innovators to expand innovative solutions beyond acute hospital settings, into broader care settings and across the entire care pathway.

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The key digital health trends COVID-19 has triggered

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Valerie Phillips, healthcare expert, and Simon Bates, life sciences expert, at PA Consulting, evaluate the trends triggered by COVID-19 that are likely to continue this year. COVID-19 is uncontestably the greatest challenge healthcare organisations across the globe have faced in recent history.

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Why interesting?

This article highlights the difficulties in relation to patient access, equity and safety when it comes to mental health services in Ireland. It is shocking that a man with a serious mental health diagnosis could be left handcuffed in the back of a police car for several hours awaiting access to the Central Mental Hospital. Latest developments show that the parties involved are fighting amongst themselves in an attempt to control the narrative of the event in the media. Meanwhile the real story of the inequality of access and safety concerns are not being given as much air time.

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Gardaí in three-hour standoff with staff at gates of Central Mental Hospital

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Gardaí engaged in a three-hour standoff at the gates of the Central Mental Hospital (CMH) last week when staff refused to admit a severely mentally ill man following a court order that he be taken there for treatment.

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Why is this news article interesting? I found this interesting as it shows Ireland's covid-19 vaccine plan. Showing which group will receive the vaccine next and how the find out if they are being vaccinated. Also shows how Ireland are doing distributing the vaccine.

https://www.irishmirror.ie/news/irish-news/health-news/ireland-vaccine-plan-groups-jab-23772543

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Despite repeated issues with supplies Ireland's vaccine roll-out continues to rumble on, with thousands more set to receive their jab this week.

A total of 654,251 vaccine doses have been administered in the Republic of Ireland up to last Thursday (March 18), with over 10% of the population now having received at least one dose.

A total of 478,725 first doses of the three vaccines currently used in Ireland have been administered, representing 10.05% of people in Ireland.

175,526 second doses have been administered, meaning 3.69% of the population are now fully inoculated.

Ireland has a vaccination rate slightly above the European average, with 13 doses administered per 100 people, according to the latest available data on March 21.

With the Government aiming to ramp up the vaccine rollout, here is all you need to know about who will be receiving their jab over the coming days.

Which groups being vaccinated against Covid-19 this week?

The focus of the vaccine rollout is currently on people aged over 70, with the HSE anticipating that between 70,000 and 75,000 vaccines will be administered this week in the over-70s population.

Those between 16 and 69 with a medical condition that puts them at very high risk of severe disease from Covid-19 are also set to receive their jab this week.

According to the government's updated vaccination plan, this group includes people with:

Chronic severe respiratory disease

Uncontrolled diabetes

All cancer patients actively receiving treatment and all patients with advanced cancers

Chronic kidney disease, on dialysis

Chronic neurological disease for example motor neurone disease

Severe immunocompromise due to disease or treatment

An intellectual disability such as Down Syndrome

It was originally planned to vaccinate people with underlying conditions in the seventh cohort, but many in this group have been moved up the list because "they would suffer the worst outcomes if they were to get the disease", according to Minister for Health Stephen Donnelly.

Frontline healthcare workers who have yet their receive their jab are also in line to receive their vaccine this week.

The HSE's chief clinical officer Colm Reid has said that he believes by the end of this week the vaccination of all frontline healthcare workers will be completed and the HSE will then move on to the next priority groups.

Mr Henry has also said he is confident the 30,000 people who missed the AstraZeneca vaccine last week will be covered over the next seven to 10 days.

The use of AstraZeneca in Ireland was paused last Sunday after concerns emerged in Norway about blood clots in patients who had received the vaccine.

It resumed on Saturday after getting the the green light from the European Medicines Agency (EMA) and Ireland's National Immunisation Advisory Committee (Niac).

Mr Reid said that those who missed out on receiving the vaccine last week, a combination of healthcare workers and people aged 18 to 69 years of age with very high-risk medical conditions, will be prioritised now that the AstraZeneca rollout has recommenced.

How are these people going to find out when/if they're going to be vaccinated?

Your GP will contact you when your vaccine is available and you do not need to register for your vaccine.

Vaccinations will be administered at a vaccination centre, GP surgery or community pharmacy.

This will be done by qualified and trained healthcare workers, including hospital doctors, community medical officers, nurses, GPs and pharmacists.

The HSE is advising people in the current cohort of high risk who are invited for a vaccine appointment to attend and receive the vaccine as soon as is if offered to them, unless they have an acute illness with a fever or have had Covid-19 or another vaccine in the last four weeks or two weeks respectively.

Which vaccine will I receive?

We have vaccines by Pfizer/BioNTech, Moderna and AstraZenca being administered here, with deliveries of the Johnson & Johnson vaccine expected to start in the next few weeks.

However, people will not get the choice of receiving one type of Covid-19 vaccine over another, the HSE chief has confirmed.

Paul Reid told Newstalk: "All vaccines are proven safe and effective and we'll be administering the vaccines based on our plans.

"It has always been our plans across all of the population based on defined risks and that's what we'll continue to do.

"There will be no situation where there's a choice of one vaccine over another.

"We'll administer it based on the safety and effectiveness of all three vaccines that we have available to us."

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Ireland's vaccine plan for the week - who's getting them and the target

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Despite repeated issues with supplies Ireland's vaccine roll-out continues to rumble on, with thousands more set to receive their jab this week. A total of 654,251 vaccine doses have been administered in the Republic of Ireland up to last Thursday (March 18), with over 10% of the population now having received at least one dose.

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Why interesting?
It shows some similarities and differences across countries. The impact of digital health care system in Denmark is also highlighted.

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What will Ireland look like when the majority of the country is inoculated? It's a question that will be asked over the coming months as the rate of vaccination ramps up across the spring and into summer.

So far, around 10% of people in the country have received one vaccine dose. And 3.7% have received a second dose.

A blueprint for how we might live exists in Israel. They've given a first dose of the vaccine to 60% of the population, and two doses to over 53%.

With the country emerging out of lockdown, Israel now operates a Green Pass system. It means people who are vaccinated carry a certificate to confirm they have received two doses, either in the form of a sheet of paper or a phone app with a QR code.

The pass is valid for six months, effective the week after receiving the second dose.

Daniel Rosehill, originally from Cork, now lives in Jerusalem. Since receiving his Green Pass, Daniel has been enjoying freedoms like the gym, swimming pools, bars, restaurants and hotels.

They all require a Green Pass to enter.

"It shows, basically, that you've had your doses. It shows what type of vaccine you had, what date you had your doses," Daniel told Prime Time.

"When you go into a gym or a bar, there is someone checking for your Green Pass. So far, they've been pretty strict across all the places I've been."

Daniel regularly travels by train or bus to Tel Aviv, where mask-wearing is still essential on public transport and in taxis.

In Israel, 60% of the population have received one dose of the vaccine

He told Prime Time that many young people flock to Tel Aviv for its nightlife, but the roll-out has been trickier with this cohort. Some regions are trying to incentivise them to get vaccinated.

"In Tel Aviv, some of the bars were doing a shot-for-shot campaign where you'd get a shot of alcohol in exchange for getting the vaccine," Daniel said.

In January, Covid-19 was surging through South Africa, with cases at almost 22,000 per day. But, despite fears about the variant first seen in South Africa, also known as B1351, cases have steadily fallen in recent months to around 1,000 cases per day.

The decline has confounded experts, since it was achieved without a stringent lockdown. The country's vaccine roll-out has also been slow.

In February, South Africa suspended its use of the AstraZeneca vaccine after it showed a low level of efficacy against mild and moderate cases of the variant.

Last week, the country's health ministry said it had sold on its unused AstraZeneca doses to other African Union member states. They had aimed to vaccinate 1.5 million people by the end of April, but that has since been revised to 500,000.

In South Africa, the government has lifted most restrictions

The government has now ordered nine million doses of the single-shot Johnson & Johnson vaccine.

Despite international concern about the South African variant, Tyrone native Sean Campbell said that the panic had subsided in Cape Town, where he is based.

"For the time being, the government has lifted most restrictions. By day, particularly on the weekends, people are out and about," Sean said.

"A lot of South Africans have commented how they have read about the variant more in the international media. When it first emerged, there was quite a bit of fear, but we pretty quickly realised that the same measures were going to help deal with it. We just had to be extremely careful."

In France, a new lockdown came into effect last Friday after a rise in Covid cases threatened to overwhelm the ICUs of Paris hospitals.

While Mandy Cherie from Donegal is confined to her apartment, many other Parisians made a break for the countryside.

"Every time the government announces there's going to be a lockdown, there's always a mass exodus from Paris," she said, noting that many would have secondary residences outside of the city.

The list of essential stores that can remain open in France includes bookshops and music stores

The lockdown comes against the backdrop of a slow vaccination roll-out in France. Around 9% of the population have had their first jab, while the AstraZeneca vaccine is only being administered to over-55s.

There is a lot of scepticism about the vaccination programme in France, partly because of how quickly regulators approved the vaccines, Mandy noted.

"Culturally the French are very sceptical, so a lot of people are waiting to see the results of the vaccine abroad before they take it themselves," she said.

While non-essential retail outlets have once again been shut, the list of essential stores that can remain open includes bookshops, music stores, hairdressers, florists and chocolate shops. People are also allowed outside, provided they stay within a 10km radius.

In Denmark, the government plans to lift restrictions once all over-50s have been vaccinated. Businesses, sports and cultural attractions will be allowed to reopen in stages throughout April and May. The country will also introduce vaccine passports, which will be required in some instances.

Passengers riding a tram in Denmark, where 11% of people have received one dose of the vaccine

So far, authorities in Denmark have administered one dose to around 11% of the population. Chris Gallagher, from Coolock, now lives in Holme-Olstrup, 80km south of Copenhagen.

"The restrictions are still quite tight, but they hope to have everyone vaccinated by the end of July. The Danes have been very disciplined. They've really listened to the government," Chris told Prime Time.

"Not everyone agrees with it, but people have come together - and they've really followed the main goals of the government."

The Danish roll-out has been boosted by the country's digital healthcare system, which allows people like Chris to access their medical history online and receive messages directly from medical professionals.

Those administering the vaccine roll-out use the system to determine which cohorts of the population should receive a jab first.

"Everything is logged into this database, so they know everything about every individual's health in the country," Chris said. "So they can pinpoint exactly who will need the vaccination first."

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Vaccines: How Ireland compares to other countries

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What will Ireland look like when the majority of the country is inoculated? It's a question that will be asked over the coming months as the rate of vaccination ramps up across the spring and into summer. So far, around 10% of people in the country have received one vaccine dose.

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What is this news article about? NIAC recommends for Ireland to temporarily stop giving out the AstraZeneca vaccine fro this morning over concerns in other countries such as Norway about people getting serious blood clots from the vaccine. this will potentially slow down the rate of people now getting the vaccine which is concerning.
https://www.irishtimes.com/news/health/covid-19-niac-recommends-temporary-deferral-of-astrazeneca-vaccine-rollout-1.4509928

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What is this article about?
This article discusses how digital technology has played a big part in the controlling of COVID-19. A foundational public health platform was created in order to contain the virus hopefully quicker with contact tracing, case management, epidemiological information collection and citizen information.

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The technology and consumer adoption of COVID-19 track and trace systems across the globe could be the turning point in mass adoption of digital healthcare solutions, spurred by the development of robust IT solutions.

As Aashima Gupta, director of global healthcare solutions, Google Cloud, noted: "The IT systems and solutions driving these rapid healthcare evolutions not only help address urgent, ongoing needs, but also establish a foundation for long- lasting improvements, particularly those that lead to systems capable of resilience in the face of future disruptions."
When benefits outweigh concern
So, if the technology is being rapidly developed to enable digital healthcare solutions, what's holding us back from extending it beyond the pandemic into day-to-day healthcare provision?

From a consumer perspective, there is a hesitance to share private medical data digitally. However, as the digital evolution of the banking sector has demonstrated, it is possible to shift consumer behaviour to accept and embrace digital options.

Simon Walsh, Strategy Director, Dept commented: "If we look at banking, we see an example of where consumer confidence in digital technology has accelerated. People are perfectly happy to use online banking because
it's so much more efficient; the benefits outweigh any concerns. As we see an increase in digital contact points within healthcare, whether that be digital GP appointments, virtual physiotherapy, or apps to advise on the management of diabetes, the behaviour will become normalised.

"When consumers see the efficacy of these systems, they will become less worried about any perceived data sharing or quality of service concerns, opening
up the opportunity for further development and adoption of centralised electronic healthcare records."

As the longevity of the pandemic increases, more and more health issues are being overlooked. Be it treatment for cancer, aches and pains, unusual lumps, headaches - the general malay that you would visit your doctor or hospital for consultation and treatment.

For example, the Irish Times recently reported that nearly 90% of women have not responded to invitations to undergo cervical cancer screening in recent months; the implications of this are extremely concerning. While we try to find the new normal in this period of uncertainty, what's being ignored and overlooked is the latter day effects on our already strained healthcare resources.
It's now just about building trust
One solution to this impending healthcare crisis is the empowerment of the patient through digital tools. Nudge behaviour, such as timely reminders for breast or prostate cancer screening, can empower citizens to manage their own health, while actively encouraging, reassuring and educating them on the safety and importance of undergoing these checks.

Research shows that effective communication between doctors and patients is linked to better health outcomes, more appropriate medical decisions, and higher patient satisfaction.

"We need to nudge consumer behaviour, even if to start off with it's just sending timely reminders," said Simon Walsh.

"By encouraging people to take more control over their health, we can empower patients, while protecting the resources of our healthcare systems. Doing so will make healthcare provision more efficient and effective. The technology already exists, as does the data protection; there are different levels of privacy, all of which can be controlled by the user, ensuring that delicate information isn't accessible out of your control. It's now just about building trust."

This doesn't feel like a massive leap from where we are today. The shift in consumer attitudes to embrace digital healthcare is already underway with apps to nudge health-impacting behaviours, whether it's the Fitbit or Apple watch, the QuitNow! Smoking app or the Drink Free Days app, the step monitor on a phone and now the track and trace apps. Data is being collected to benefit the users' health, it's just not as obvious as a direct link to their medical files.

The healthcare industry has been able to respond quickly to the challenges of the pandemic thanks, in large part, to the new technologies and processes that it's been slowly rolling out for several years. These technologies are digital-first, open and scalable, so can easily be deployed quickly for

new use cases. The agility of modern technology helps the industry make use of existing systems and services in new ways going forward. Google, for example, provides a chatbot that healthcare providers can integrate into their own systems.

The chatbot can start the conversation with the patients and collect relevant information before handing them off to a live video connection with a healthcare professional. Providers can also launch Google Meet, the company's video conferencing solution from within an electronic health record, giving doctors access to and the ability to modify records in real time.
Digitisation of healthcare will remain a top priority
The digitisation of healthcare is clearly an ongoing priority, as shown by governments across the world. Australia has developed the National Digital Health Strategy and set up My Health Record as an opt- out medical record for all Australians.

The UK has established NHS Digital and NHSX to transform NHS and social care, and the Danish government has announced investment into an app-based platform known as the World-Class Digital Service (WCDS) that can be used to access all publicly held data on Danish citizens.

In the midst of this progress, there are challenges that will remain, as with any industry undergoing such a major transformation: costs, complexity, evolving needs and scenarios, and ongoing privacy issues.

It's clear, however, that we've turned a corner in the healthcare industry to a future that is focused on prevention, innovation and access for all citizens, all at the touch of a fingertip.

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Why digital is the solution to the healthcare crisis

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The technology and consumer adoption of COVID-19 track and trace systems across the globe could be the turning point in mass adoption of digital healthcare solutions, spurred by the development of robust IT solutions.

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What is this article about?
This article discusses and new innovation in relation to 'health' had been implemented throughout Dublin 8. The articles states that one in three of the Dublin 8 residents suffer from mental health issues.
This innovation aims to introduce pilot projects such as more open green spaces in their community.They aim to increase healthcare inequalities by partnering with the local healthcare workers and medical professionals to achieve this

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A new initiative in aiming to improve the health and wellbeing of people in Dublin 8 through innovation and collaboration.

Smart D8 will see locals and community organisations joining research, health, industry and educational institutes to innovate for better health outcomes for people living in the area.

The creation of a health innovation district in the area, that will provide a focal point for innovators working to develop product, service or technology solutions, is a key element of the programme launched by Minister for Further and Higher Education, Research, Innovation and Science Simon Harris on Wednesday.

Research shows that one in four Dublin 8 residents accessed mental health supports in the last two years, and one in three have a long-term health challenge.

Groups interested in participating in Smart D8 can respond to the first call for pilot projects, which will focus on the impact of Covid-19, mental health and population health.

Speaking at the launch, Austin Campbell of the Robert Emmet Community Development Project and the Community Organisations and Residents Network (CORN), said Dublin's southwest inner city is an "anomaly".

"It's full of strong characters and it's got a strong sense of identity and cultural heritage. It's got very strong stakeholders in the area . . .the area is full of potential."

Dereliction and lack of green space

However, Mr Campbell added that one fifth of people in the area can't numerically understand an electricity bill. "There is a high level of dereliction and an over-concentration of vulnerable populations, a relative lack of green space compared to other areas.

"These things only occur at that sort of frequency in an area where community members can't effectively express themselves."

He added that Robert Emmett CDP and CORN aim to empower the community, and Smart D8 can help achieve this.

Local GP and the HSE's national director of quality improvement, Dr Philip Crowley, said health authorities need to partner with local communities to combat negative health outcomes and inequality.

"The [medical card patients lack of] access to secondary care is a real problem, it is very, very unequal.

"Minority groups experience additional obstacles to healthcare, and we need targeted approaches to tackle those."

Peer-led support, early years and adult education and job opportunities are also important in improving wellbeing, according to Dr Crowley.

He added that the literature shows that community partnerships such as Smart D8 have improved health outcomes in other countries.

"We need to design interventions together, we don't need experts coming with external expertise, we need community expertise [AS WELL]."

Smart D8 project leads include The Digital Hub, St James's Health Campus , Dublin City Council and Smart Dublin.

People interested in taking part can visitsmartdublin.ie/smart-districts/smart-d8/.

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New 'health innovation district' aims to improve wellbeing in D8

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A new initiative in aiming to improve the health and wellbeing of people in Dublin 8 through innovation and collaboration. Smart D8 will see locals and community organisations joining research, health, industry and educational institutes to innovate for better health outcomes for people living in the area.

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What is this article about?
This article discusses the rise in eating disorders and attributes it to the mental health crisis brought about by the Covid- 19 pandemic.

Why is it interesting?

The article mentions a GP working in a student health centre who states that on a given morning 50% of her patients have mental health issues as part of their reason for visiting. There is no doubt that the Covid-19 pandemic will have a lasting impact on our nation’s mental health and mental health care provision. The GP also states that the number of patients presenting with eating disorders has increased during the pandemic. The article sates that eating disorders can serve as a coping mechanism though providing the individual with a sense of control over their lives, something many of us ow feel is lost.

https://www.thejournal.ie/readme/eating-disorders-covid-impact-students-5354577-Feb2021/

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See more articles by Dr Aoife O'Sullivan

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'More and more students are coping with anxiety through either restricting their eating or binge eating'

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Dr Aoife O'Sullivan, a GP treating UCC students, writes about the impact of the pandemic on her patients.

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What is this article about?
A new report states that respondents are more often using drugs to cope with mental health problems.

Why is it interesting ?
The article discusses the use of psychedelic drugs as a “self-treatment”. The article also points to research into the use of these drugs as a legitimate therapeutic tool. While further research is needed, it is clear that they may play a part in the future of mental health treatment.

Interestingly, while these drugs are illegal, people still choose to use them for medication suggesting the benefits they produce for many users outweigh the legal risk. This is of course speaking only about those who use these drugs as medicine and not to the recreational users.

https://www.thejournal.ie/psychedelic-drugs-depression-5372799-Mar2021/

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What is the news about?
This article highlights the domestic abuse that people are experiencing around the world, including Ireland. Due to the Covid-19 restrictions to people, cases of domestic abuse in Ireland have increased. It also suggests the impact of mental health on people during the pandemic have an association to domestic abuse victims and vice versa.
Why is it interesting?
It is interesting as that it gives a brief information in the mental health services that if offered by the government for the people, through phone apps and emergency contacts for this problem. The issue of mental health and domestic violence has been an ongoing problem worldwide, especially during the pandemic. An easy access for safety is very important these days.

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"Domestic violence is a crime, and no one deserves to feel controlled, threatened, be assaulted or to live in fear."

That is the view of consultant psychiatrist Prof Gautam Gulati of the University of Limerick's school of medicine. It is a timely observation, following an investigation he undertook with consultant psychiatrist Prof Brendan D Kelly of Trinity College Dublin into domestic violence during the Covid-19 pandemic, and published in the International Journal of Law and Psychiatry.

Prof Gulati says that Covid-19-related measures seem to be associated with an increased risk of domestic violence: "Social isolation, exposure to financial and psychological stressors, an increase in negative coping mechanisms - such as alcohol or substance misuse - appear to play a part. For victims, an inability to access support mechanisms or escape abusive households, owing to quarantine measures or travel restrictions, heightens vulnerability."

Prof Gulati and Prof Kelly cite evidence showing that since governments around the world restricted travel to prevent the spread of Covid-19, concerns about domestic violence have been expressed in many countries, including China and Italy.

"And in Ireland, " Prof Gulati explains, "there is evidence that An Garda Síochána received 25 per cent more domestic violence-related calls in April/May 2020 compared to a year earlier. Organisations who play a crucial role in supporting victims also reported substantial increases in calls for help. This rise is in keeping with the international picture seen in countries such as France, China, Italy, and the UK."

Global challenge

And the nature of this global challenge is confirmed by research Frontiers | Editorial: New Perspectives on Domestic Violence: From Research to Intervention | Psychology reporting that one in four women in EU member states have been affected by domestic violence, with consequences including "lack of self-esteem, feeling shame and guilt, difficulties in expressing negative feelings, hopelessness and helplessness, which, in turn, lead to difficulties in using good coping strategies, self-management, and mutual support networks".

Prof Gulati and Prof Kelly considered whether mental health services have a specific role to play in addressing increased domestic violence during this pandemic, and they make three main points.

First, although there is an association between mental illness and violence, the vast majority of people with mental illness will never be violent;

If you are suffering domestic violence right now, get out of the situation as best you can

Second, people with severe mental illness are at increased risk of becoming victims of domestic violence;

And third, as the Covid-19 pandemic has evolved, "referral rates to mental health and psychology services decline during lockdowns, despite a likely increase in psychological distress, victimisation and mental illness".

Gulati and Kelly are concerned at the possibility "that many people are not seeking help owing to fears that services are overwhelmed, and that attending face-to-face appointments might put them at risk."

Mental health services

Yet, as Prof Gulati emphasises, mental health services are key to providing continuity of care, especially for marginalised populations such as the homeless; people with severe illness; people with comorbid drug or alcohol use disorders; and the many people with mental illness who live in poverty: "A lack of consistent and assertive follow-up," Prof Gulati argues, "will increase risks of mental illness, physical ill-health - including Covid-19 - and domestic violence, especially among potential victims who may depend on mental health services for safety, advocacy and facilitating the wellbeing of their children. It is therefore vital that parity of esteem is maintained for mental and physical health services over the course of this pandemic."

What practical steps can be taken by victims of domestic violence?

Prof Kelly is clear: "If you are suffering domestic violence right now, get out of the situation as best you can. Do your best to adhere to the public health guidelines and restrictions as you do so, but remember that your personal safety, and that of your children, is an urgent matter, even in a pandemic."

Some countries have developed phone apps allowing victims to seek help and make hotel rooms available for those at risk

Prof Kelly further advises that if necessary, ring your local Garda station or, in an emergency, 999. "You can also ring the Women's Aid National Freephone Helpline on 1800 341 900," he says, adding that the helpline is open 24 hours a day, seven days a week: "If you feel you cannot do these things, reach out to someone with whom you can talk: a family member, a friend or someone else. Remember, the Covid-19 pandemic and the public health restrictions do not mean that anyone has to stay in a situation of domestic violence."

Phone apps

Offering a broader perspective, Prof Gulati notes that some countries in Europe have developed phone applications allowing victims to seek help and make empty hotel rooms available for those at risk. Addressing domestic violence, explains Prof Gulati, requires a careful combination of legal measures - arresting perpetrators, barring orders, safety orders; societal responses - bystander responses, advocacy services, shelters; and heightened awareness in frontline community services like medical services, where victims can present with physical or psychological trauma, sexually-transmitted infections, neglect or other sequelae of abuse. "There are key roles," he says, "for mental health services in the identification and management of certain risk factors like substance misuse and providing support, advocacy and treatment services to victims.

"It is crucial that both mental health services and the charities sector, which supports victims, are supported by governmental policy and adequate resourcing through the pandemic."

Supporting charities

And Prof Gulati and Prof Kelly further underline the importance of supporting charities such as Women's Aid "who provide an indispensable service and are often the first point of contact for victims".

In 1993 the World Conference on Human Rights asserted that violence against women is a human rights concern, affecting their fundamental human dignity. Delegates' demands included the elimination of sexual harassment and the eradication of conflicts between the rights of women and the harmful effects of "certain traditional practices, cultural prejudice and religious extremism".

Almost three decades later, the work of Profs Gulati and Kelly reminds us of the continuing importance of that message.
Read: 'It's the kids we don't know about. That is the worry'

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Living in fear: domestic violence during the Covid-19 pandemic

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"Domestic violence is a crime, and no one deserves to feel controlled, threatened, be assaulted or to live in fear." That is the view of consultant psychiatrist Prof Gautam Gulati of the University of Limerick's school of medicine.

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**Week 7 - Frances Paña** What is the news story about? Thew news highlights the domestic abuse are experiencing in around the world, including Ireland. Due to covid-19 restrictions to people, cases of domestic abuse in Ireland have increased. It is also suggested that the impact of mental health on people during the pandemic have an association to domestic abuse and vice versa. [https://www.irishtimes.com/life-and-style/health-family/living-in-fear-domestic-violence-during-the-covid-19-pandemic-1.4465263](https://www.irishtimes.com/life-and-style/health-family/living-in-fear-domestic-violence-during-the-covid-19-pandemic-1.4465263)Why is it interesting?This article is particularly interesting due to the fact that covid-19 have started over a year ago now and the fact that there hasn't been a proper announcement in

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**Week 7 - Frances Paña** What is the news story about? Thew news highlights the domestic abuse are experiencing in around the world, including Ireland. Due to covid-19 restrictions to people, cases of domestic abuse in Ireland have increased. It is also suggested that the impact of mental health on people during the pandemic have an association to domestic abuse and vice versa. [https://www.irishtimes.com/life-and-style/health-family/living-in-fear-domestic-violence-during-the-covid-19-pandemic-1.4465263](https://www.irishtimes.com/life-and-style/health-family/living-in-fear-domestic-violence-during-the-covid-19-pandemic-1.4465263)Why is it interesting?This article is particularly interesting due to the fact that covid-19 have started over a year ago now and the fact that there hasn't been a proper announcement in

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COVID-19 in pregnancy is not linked to still birth or baby death but could be linked to premature birth, new research suggests.

The study looked at 4,004 pregnant women from the UK and US who had suspected or confirmed COVID-19.

All the women gave birth between January and August 2020.

As well as no deaths amongst babies in the study, the proportion of babies born to mothers with COVID-19 who subsequently tested positive was low at around 2% in the UK and 1.8% in the US.

There was also no increase in the risk of still birth and low birth weight.

However, there was a link between suspected or confirmed COVID-19 with a higher risk of premature birth in both the UK and US data.

Professor Christoph Lees, senior author of the study, said the reason for this was "not entirely clear".

In the UK, 12% of women with suspected or confirmed COVID-19 had a pre-term delivery - 60% higher than the national average of 7.5%.

Meanwhile in the US, 15.7% of women had a pre-term delivery - 57% higher than the US national average.

According to the study team, this could be partly associated with doctors deciding to deliver early, due to concerns about the effect of COVID-19 infection on mother and baby.

Despite a higher number of premature births, the rate of deaths among the women, most of whom had no pre-existing health conditions, was similar to the expected death rates seen amongst adults with COVID-19. This suggests pregnant women are not at higher risk than non-pregnant women.

Professor Fiona Watt, Executive Chair of the Medical Research Council which helped fund the research, said: "The study's findings, that there is no increased risk of still birth and early neonatal death in women who contracted COVID-19 while pregnant, are reassuring. However, the study highlights a need more research to determine if, or how, COVID-19 affects maternal outcomes or premature birth."

Dr Ed Mullins, co-author from Imperial department of metabolism, reproduction and digestion, also emphasised "a prioritisation of vaccination of women who are pregnant or who plan to become pregnant" for reducing pre-term births.

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COVID-19 in pregnancy not linked to still birth or baby death, new study suggests

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COVID-19 in pregnancy is not linked to still birth or baby death but could be linked to premature birth, new research suggests. The study looked at 4,004 pregnant women from the UK and US who had suspected or confirmed COVID-19. All the women gave birth between January and August 2020.

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The Mental Health Commission criticise   St. Catherine’s Ward, located on the grounds of St. Finbarr’s Hospital on the Douglas Road in Cork.

The piece in the Irish Examiner    depicts Ireland's mental health severices  at it worst. This is down to it's  lack of funding and the poor  living  conditions of  patients at the ward.

This interested me as it was shocking to see a developed states as Ireland have a mental health facility of the 50’s.  Patients had set time to wake and sleep, due to this were not allowed to take nap during the day according to the last inspection. The staff at the facility lacked the skills in which  the patients  truly needed. The were understaffed  as there  were not  enough dietitians and speech and language therapists. The mental ward had been said to brake state regulation due to the use of electroconvulsive therapy (ECT).

There was a lack of human dignity  of patient at the Cork facility, due to shortage  of staff patient were  locked in their rooms during the day. The rooms  had with on curtain and were  poorly  maintained. Patients bodily  health was being affect too,  being subject to environmental   injustice. In the facility they  were subject to second hand smoking and faced with a displeasing view of cigarette butts and litter on the ground.

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The Mental Health Commission has criticised a Cork city mental health unit for locking residents' bedroom areas until 9:30pm at night, thus preventing them from sleeping or resting during the day.

St. Catherine's Ward, located on the grounds of St. Finbarr's Hospital on the Douglas Road in Cork, made residents vacate their bedrooms in the morning, according to an inspection report.

The report also said staffing levels and their skill mix were not sufficient to meet residents' needs, as the centre did not have enough dieticians and speech and language therapists.

Short staffing also contributed to the bedrooms being locked during the day, and the report also stated there were no curtains on the windows in several bedrooms.

The Mental Health Commission (MHC) also said the condition of the premises was poor.

It found no programme of general maintenance, decorative maintenance, cleaning, decontamination or repair of assistive equipment.

The courtyard area had cigarette butts and litter on the ground. One of the bedrooms had a hole in the wall and chipped paintwork, according to the report.

There was also an area in the centre which smelled of cigarette smoke, and the floor and a plastic chair displayed burn marks.

St Catherine's is a 21-bed centre, and there were 19 residents at the time of the inspection.

The report found the centre was high risk non-compliant on six regulations, despite the fact its compliance with regulations went up from 62% in 2019 to 72% in 2020.

These regulations related to the transfer of residents; privacy; the condition of the premises; ordering, prescribing, storing and administration of medicines; staffing and the admission, transfer, and discharge of patients.

The centre also had one moderate non-compliance for food safety and one low non-compliance with personal property and possessions.

Lakeview Unit in Naas General Hospital in Kildare was also inspected, and the Mental Health Commission found issues with the space available in the premises as well as the use of electroconvulsive therapy.

The centre was rated high risk non-compliant on one regulation relating to the premises, and received another five moderate non-compliances.

These moderate non-compliances related to the transfer of residents; the maintenance of records; rules and codes governing the use of electroconvulsive therapy (ECT); and the admission, transfer and discharge of patients.

While there had been an increase in compliance, up from 62% in 2019 to 72% in 2020, the MHC said that Lakeview was not suitable for the care of people with a mental illness.

The report said residents did not have sufficient access to personal space or an appropriately-sized communal room, as there was only one sitting room which could not accommodate all residents at full capacity.

The Mental Health Commission also warned that due to a lack of beds, some in-patients are not being treated as close to home as possible.

This means that visits from family and loved ones are difficult to arrange.

The Chief Executive of the Mental Health Commission, John Farrelly, said Lakeview Unit was one of the units experiencing bed shortages.

According to an inspection report, the 29 beds available in Lakeview is not enough for its catchment area of Kildare and west Wicklow, which has a population exceeding 241,538.

The hospital had to arrange for some patients to be accommodated 50km away in the Department of Psychiatry in Portlaoise.

Mr Farrelly said that patients dealing with a serious mental illness need visits from loved ones.

"When people are acutely ill and undergoing treatment, ideally they should ideally remain within their locality. Maintaining close linkages with friends, family and their community during their illness contributes to a reduction in stigmatization of patients in their community and helps with recovery."

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Bedroom area of Cork mental health unit locked until 9.30pm

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The Mental Health Commission has criticised a Cork city mental health unit for locking residents' bedroom areas until 9:30pm at night, thus preventing them from sleeping or resting during the day. St. Catherine's Ward, located on the grounds of St.

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Ireland’s Covid-19 vaccine roll-out: How do we measure up on a global scale?

This article discusses how Ireland is currently above the EU rate with 3% of our population fully vaccinated.

Why is this interesting?
This article is interesting because it outlines the vaccines rates in Ireland in comparison to other countries such as the United Kingdom, United States, Israel, Germany, Italy, Spain, France and the Netherlands. It also explains that Ireland is expecting to administer  the first dose of the vaccine to 80% of the population by the end of June. This is some reassuring news for the population of Ireland as they will be able to finally enjoy their lives again.

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Ireland is currently above the EU average with 3pc of our population fully vaccinated.

pc of our population has received at least one dose of vaccine and 8.8 doses per 100 of our population have now been administered.

It is expected that the 500,000th dose will have been administered within the next week.

Vaccine deliveries for the month of March are still being finalised with manufacturers.

The latest figures come as the vaccine roll-out programme received criticism in recent days as it emerged the target of 100,000 doses being administered last week was not reached due to a deferral of delivery from AstraZeneca.

The Government continues to reiterate it's target to offer the first dose of the vaccine to more than 80pc of the population by the end of June.

As of Sunday, 435,895 vaccines were administered - 294,550 first doses and 141,345 second doses, HSE figures have shown.

More than 50,000 people aged over 70 - Cohort 3 in the vaccine priority list - have now received their first dose.

In the North, 537,389 people had received their first jab by March 1st, while 35,370 are fully vaccinated.

Ireland currently ranks eighth in the European Union for highest vaccination rate behind Malta, Hungary, Lithuania, Denmark, Poland, Greece and Cyprus, but how does it compare on a global scale?

United Kingdom

The United Kingdom currently leads against the rest of Europe in terms of vaccinations per capita of the population, with over 20 million doses administered so far.

The UK's number of vaccinations per 100,000 people currently stands at 32,258, compared to Ireland which stands at 9,014 per 100,000 people.

British Prime Minister Boris Johnson's roadmap out of lockdown sets a date for normality to resume with hopes that the majority of restrictions on mass gatherings will be lifted from 21 June.

However, cases continue to rise in the UK as the total number of cases has surpassed 4.1 million, with over 124,000 deaths.

United States

In the United States, 52.9 million people have received at least one dose of a Covid-19 vaccine, with 27 million people now fully vaccinated, according to the Centers for Disease Control and Prevention.

An average of 2.01 million doses are being administered daily and President Joe Biden has promised to administer 100 million vaccines by his 100th day in office.

The US continues to lead with the highest number of cases in the world at 28.8 million, with more than 518,000 deaths from Covid-19.

The priority group in the vaccine roll-out mirrors Ireland's plan to vaccinate health care workers and residents of long-term care facilities first.

Israel

Israel currently leads with the fastest vaccination programme in the world as 52pc of the Israeli population of 9 million have been administered a Covid-19 vaccine.

The Asian country's vaccination plan gave new hope to the rest of the world as new data shows that just one in 1,500 fully vaccinated Israelis tested positive for Covid-19.

Israel has even begun administering vaccines to some of the younger cohorts, including those aged 16-18 and 19-21.

The country has unveiled the internal Covid-19 vaccine passport known as the "Green Pass", an initiative created by Israel's Ministry of Health in a bid to incentivize those who don't wish to be vaccinated and boost the economy.

The "Green Pass" is available in both digital and paper form, and is offered to anyone who has received both doses of the Covid-19 vaccine through any one of Israel's health maintenance organizations.

Germany

6,174,362 doses of Covid-19 vaccinations have been administered in Germany since the approval of the BioNTech-Pfizer vaccine in the EU, with the over 80's age group receiving the majority of doses.

The German government has come under criticism for it's slow vaccination and testing programmes and has yet to offer the nation a roadmap out of the crisis, remaining far behind countries such as Britain, Israel and the US.

A lack of supply and growing concerns of lingering side effects in relation to the AstraZeneca vaccine have contributed to the delayed roll-out.

Germany has seen a total of 2,471,900 confirmed cases of coronavirus and 71,240 deaths, according to the Robert Koch Institute, its public health institution.

Italy

1.4 million people in Italy have received both doses of a Covid-19 vaccine, amounting to 2.3pc of it's 60 million population, according to the latest official data by the Italian Government.

Italian Prime Minister Mario Draghi released an acceleration plan on Monday which aims to have 56 million doses administered by June.

Around 108,000 doses are currently being administered daily, however the Italian government said the aim is to increase it to 200,000 doses per day, according to Italian media outlets.

The number is set to rise to 400,000 per day in April, the equivalent of 12 million doses per month.

Italy has seen a total of 2.98 million cases of coronavirus and 98,635 deaths.

Spain

Spain has administered a total of 4.5 million doses of a covid-19 vaccine and 1.2 million people have been fully vaccinated.

The first priority group, seniors in residences and their carers, is almost complete, while the second, frontline health workers, are currently receiving their second doses.

The Spanish government has set a target of having 70pc of the population vaccinated by the summer, according to WHO.

Spain has had 3.14 million cases of coronavirus and 70,247 deaths.

France

Around 3 million people have received at least one dose of a Covid-19 vaccine in France so far.

France's vaccination plan has been sluggish since it began in late December, with 6.7 vaccine doses per 100 people in its population administered as of February 28, French media reports.

This is in contrast to the 31 vaccine doses per 100 people in the UK, where more than 20 million doses have been administered, which has roughly the same population as France.

France has had a total of 3.81 million cases and 87,542 deaths.

The Netherlands

The Netherlands was the last EU country to begin vaccinations, beginning in early January.

The country aims to offer the jab to all adults in its 17 million population by the end of September.

The vaccination programme has been lagging so far with just 3.6 doses given per 100 people, making it the second slowest in the EU in administering vaccines.

However, the Dutch government has ordered 85 million doses from eight companies.

The Netherlands has had a total of 1.1 million cases of covid-19 and 15,697 deaths.

Online Editors

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Ireland's Covid-19 vaccine roll-out: How do we measure up on a global scale?

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Ireland is currently above the EU average with 3pc of our population fully vaccinated. pc of our population has received at least one dose of vaccine and 8.8 doses per 100 of our population have now been administered. It is expected that the 500,000th dose will have been administered within the next week.

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This article examines a new way of detecting colon cancer has been discovered by two Cork scientists. A light-based instrument which is non-invasive is being developed to identify the disease.

Why is this interesting?

Colon cancer is the third most common form of cancer in the and the second most deadly and this new development senses and differentiates tissues including tumours more accurately and faster.

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Scientists based in Cork have developed a more effective and less invasive way to diagnose and treat colorectal cancer, which is the third most common type of cancer in the world and the second most deadly.

The advance has been achieved by researchers at Tyndall National Institute in Cork in partnership with clinicians at Mercy University Hospital (MUH) and Cork University Hospital (CUH).

They have created a tool for non-invasive surgical guidance and early disease detection using biophotonics technology; a light-based instrument that senses and differentiates tissues including tumours more accurately and faster.

The team's research has been published in the scientific journal Nature, and proves the use of biophotonics can help to radically improve health outcomes for patients as it is less invasive and provides more comprehensible information to clinicians and surgeons in real time - particularly in the area of colon cancer.

Pre-clinical and clinical studies with patients who have gastrointestinal diseases and oral cancer are due to commence in the MUH and CUH later this year.

Marcelo Saito Nogueira from the biophotonics team said clinical interventions have been significantly improved by recent advances in devices for diagnostics and surgical guidance. Most used imaging technologies provide key indications "only detectable at a late stage in the disease".

He added: "The tools we are developing will be more beneficial as they identify and locate disease at an earlier stage based on molecular changes, If accurately detected, the disease can be fully treated in less procedures and the risk to the patient and number of cancer surgeries would be reduced."

The team are using optical spectroscopy and imaging techniques that are promising "molecular-sensitive tools" with potential to monitor diseases and guide surgical procedures by providing a non-invasive, fast and in situ interrogation of biological tissues.

"We have shown that by selecting fine wavelengths of light it is possible to differentiate the molecular structure of cancerous versus non-cancerous cells," he explained.

Colon cancer fatalities worldwide

These techniques can be cost-effective and integrated into existing clinical tools, which enhances their potential to improve current healthcare and also makes them commercially attractive, said Mr Nogueira. "We also look forward to collaborating in the future with one of the numerous medical device companies located in Ireland. "

Colon cancer accounts for more than 9 per cent of all cancer deaths worldwide and this is estimated to increase by 71.5 per cent by 2040.

The biophotonics team at Tyndall, which is based in UCC, is researching non-invasive techniques that are more accurate and faster than conventional detection methods. They are now developing a probe for colon cancer detection during colonoscopy, which can investigate additional types of biomolecules located at different tissue depths.

This will help surgeons to take biopsies at the right places - as they have no guidance as to where to request a biopsy - which will obviate the need for multiple biopsies. It could also help identify more subtle abnormalities such as premalignancies invisible through colonoscopes and medical devices.

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Breakthrough by Cork scientists on colon cancer detection

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Scientists based in Cork have developed a more effective and less invasive way to diagnose and treat colorectal cancer, which is the third most common type of cancer in the world and the second most deadly. The advance has been achieved by researchers at Tyndall National Institute in Cork in partnership with clinicians at Mercy University Hospital (MUH) and Cork University Hospital (CUH).

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This article talks about why the HSE issued an alert with regard to Covid-19 and stillbirths. This article is interesting because it shows that there is now a possible connection between a Covid-19 infection of the placenta and woman having stillbirths. Two of these stillbirths were counted in Nphet’s daily mortality numbers on Thursday. Although this could still be proven to be a coincidence, this article is important for women and everyone in contact with a pregnant women to take extra care to stop themselves from getting the virus.

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A number of stillbirths among women with Covid-19 has prompted separate alerts from the Health Service Executive (HSE) and the Institute of Obstetricians.

The alerts have been sent to maternity staff across the country after postmortems identified Covid-19 infection of the placenta as a factor in four recent stillbirths.

On foot of the postmortem findings, two separate coroners took the unusual step of contacting the HSE directly with their concerns. The women had mild or moderate symptoms of Covid-19, but were not very unwell.

The stillbirths, which occurred in the first two months of this year, have yet to be examined at inquests, which are not bound to follow the findings of the postmortems.

Dr Ronan Glynn, Deputy Chief Medical Officer said on Thursday evening: "We have been made aware of four preliminary reports of stillbirths potentially associated with a condition called Covid Placentitis.

"These reports should be interpreted with caution as the coroners have not yet concluded their findings. The HSE's National Women and Infants Programme is aware of and is monitoring the situation and has issued a related notice to obstetric departments.

"I would ask that the privacy of all of those affected by this disease continue to be respected at all times."

Two of the stillbirths were included in Nphet's daily mortality figures on Thursday evening.

Meanwhile, while international experience showed it was "not unusual" for Covid-19 to cause placental infection, stillbirth was an "unusual complication", Prof Peter McKenna, head of the HSE women and infants health programme, told The Irish Times.

The fact four stillbirths had occurred in a short time and among the small population of women with Covid-19 had raised concerns, prompting the HSE to issue the alert, he said.

Despite the absence of international evidence for Covid-related stillbirth, it was decided to issue the alert on a precautionary basis.

In each of the cases, pathologists found the placenta from the women who had Covid was inflamed, thereby impairing blood flow to the fetus.

There has been no overall increase in stillbirths during the pandemic, research from the US and UK indicates.

A study from Cork, in relation to one woman with the virus who gave birth successfully by emergency caesarean, found placental inflammation was an uncommon complication of infection but appeared to have the potential to cause "significant placental injury, potentially resulting in fetal compromise".

Prof McKenna urged pregnant women to do all they can to protect themselves from getting Covid-19. As a result of the postmortem findings, expecting mothers who have had Covid-19 are likely to be monitored more intensively and for longer than normal as a precaution, he said, and may be induced or delivered earlier.

"I'd be cautious about drawing too much from this. It could be an unfortunate coincidence," said Dr Cliona Murphy, chairwoman of the Institute of Obstetricians.

She urged pregnant women who test positive for Covid-19 to get a check-up as soon as their isolation period was finished, and not to hesitate about seeking medical attention if they have concerns.

In January, the HSE said 548 pregnant women had tested positive for the virus during the pandemic, but this is regarded as an underestimate. Some 41 were hospitalised and under five required admission to ICU.

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Four stillbirths among women with Covid-19 prompt HSE alert

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A number of stillbirths among women with Covid-19 has prompted separate alerts from the Health Service Executive (HSE) and the Institute of Obstetricians. The alerts have been sent to maternity staff across the country after postmortems identified Covid-19 infection of the placenta as a factor in four recent stillbirths.

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This article reports on the  setting up of Specialist 'long Covid' clinics for  covid patients in England. The Clinics aim to help people across the UK suffering persistent health problems having had Covid 19. The most common symptom identified to date of  long term covid is crippling fatigue, with estimates that 1 in 10 of those infected with the virus could be impacted.

Why is interesting?

This is an area requiring much needed investment.  Importantly the Clinics provide one-stop services for physical and mental health issues. The news article also references other supports currently being established:

clinical guidelines on support for long-Covid patients

an online rehab service called Your Covid Recovery

research on 10,000 patients to better understand the condition

a long-Covid taskforce, to include patients, medical specialists and researchers

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Coronavirus: Specialist 'long Covid' clinics to be set up in England

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They will offer support for people with long-term health problems after infection with coronavirus.

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This article looks at the potential for digital innovation in healthcare to reduce existing inequalities. It notes that while Covid-19 has seen an overall increase in digital innovation, such advances tend to benefit those from higher socio-economic groups first. In order to address that disparity, innovation must have a univeral benefit, and this article outlines the ways in which this could be addressed. It covers the areas of equity, efficiency and access.

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Can digital innovation reduce healthcare inequalities?

By Ben Marshall - Healthcare UK - World Healthcare Journal

Covid-19 overshadows all our lives. But just because we are battling the same storm does not mean we are all in the same boat. The people likely to be most exposed to coronavirus, and to suffer most from the resulting interventions, are disproportionally those already disadvantaged in society (the #ethnic-breakdown-of-deaths-by-age-and-sex">startling disparity between white and BAME outcomes is one tragic example).

This inequality predates the pandemic. Even in the NHS - the world's most mature system of universal healthcare coverage - morbidity and mortality are strongly correlated with where a person lives and how much they earn.

If these dark clouds have a silver lining, it is that the pandemic has also highlighted the most effective tools to repair this imbalance: chief among them is digital innovation. Below are some key lessons that healthcare professionals, politicians and scientists should consider as they tackle discrimination in the digital age, and examples of what can be achieved in a variety of care settings when innovation (digital and otherwise) is applied with care.
Mobile tools for fairer access to consultations
It seems increasingly common to hear that the last ten months have seen 'ten years of innovation'. But while services like video consultations have certainly become more widespread, start-ups like DrDoctor and Zesty had already developed a variety of remote care tools, from appointment management apps and text updates, to self-monitoring questionnaires and paperless referrals.

Solutions like these are convenient: improving patient choice, shortening waiting times, and significantly reducing overhead costs. But there is a risk, says Lloyd Price, Co-Founder of Zesty, that "technology always starts by benefitting the most affluent, educated, and digitally mature people in society" because "the focus tends to be on cutting edge platforms. Innovation can't just be for the early adopters at the 'top of the pyramid'; it needs to be for everyone. "

By taking advantage of near-ubiquitous technology like mobile phones, we might finally see all sections of society able to effectively manage their own care. Shift workers could flexibly report on chronic conditions; those living with financial insecurity could consult a GP without incurring holiday or travel costs; and homeless people could receive timely diagnoses without needing to rely on a discriminatory paper-based approach.

Universal benefit does not require universal uptake. Those unwilling or unable to engage online still benefit by 'delegating access' to their carers or when automated booking systems free up clinic phone lines. Tom Whicher, Founder and CEO of DrDoctor, believes this combined approach is vital. " Digital transformation can help everyone by bridging gaps in health inequality. But the way to do it is not to force digital products on everybody and alienate them from their own health journey. New tools need to work with, rather than replace, existing behaviour. "
Integrated analytics to improve planning of local services
Effective case management, while a perk for patients, is vital for healthcare organisations. This was the challenge faced by boroughs in North West London when they were hit hard by the first wave of the pandemic. Facing a critical incident, North West London Collaboration of Clinical Commissioning Groups (the local body responsible for planning and procuring clinical services) enlisted the support of analytics company TrueCue to help them combine, sort, and understand the vast array of information they were dealing with.

In only four weeks, TrueCue and NWL launched a reporting platform to integrate data from almost 20 source systems and display it in near-real-time using a variety of 'dashboards'. Clinicians and managers are now using these reports to spot trends earlier, identify high risk groups, and plan interventions.

James Don-Carolis, Managing Director at TrueCue, emphasises the importance not only of combining inputs, but also sharing outputs widely. "Integrating disparate data sources is vital for holistic, evidence-based decision making. But you only see maximum value if the information can be accessed by teams in multiple care settings, including hospital staff, central leadership teams, and GPs. This collaboration is the only way of managing caseloads without losing a patient-centric view. "
An online portal to help ageing patients access care
Other organisations like North of England Commissioning Support Unit (NECS) have made the opposite transition: taking existing innovations and re-purposing them to deal with Covid-19. In 2019, NECS - one of a handful of units providing business intelligence, consulting, and back-office support to other parts of the NHS - launched 'Capacity Tracker', an online portal to address the significant delays that exist when moving patients from hospital to a care setting.

There was historically no way of searching care homes and matching the requirements of individual patients, but Capacity Tracker allows social care teams to find and fill vacancies more easily, saving time and anxiety, and freeing up critical hospital beds. As well as working with more than 15,000 care homes, it is now being used across other settings such as community rehabilitation and drug and alcohol services.

Stephen Childs, Managing Director at NECS, believes this growth in uptake "is an example of how local innovation can be rapidly adopted at a national level without the high initial overheads of a top-down approach". The UK Government has used it to support the national pandemic response (providing real-time insight on PPE, workforce requirements and flu immunisations) and it been adopted for the same reason by a primary health network in Australia.
Diversity works both ways
Just as technical innovations can support under-served populations, increasing diversity also improves technical innovation. One example is in genomics, where recent advances have opened vast new possibilities for the diagnosis and management of rare diseases.

The UK is a world leader, and NHS Trusts, private organisations, and Genomics England have begun partnering with other countries to share their expertise. However, most genomic studies focus on participants of white European ancestry, and this ethnicity bias is impeding the equitable sharing of clinical benefits and the advance of scientific knowledge.

Dr Saghira Malik Sharif, Principal Genetic Counsellor for Prenatal Genetics at Leeds Teaching Hospital, believes that the way to increase participation is through broader education. "The key issue," she says, "is to develop researchers with cultural - as well as clinical - competencies. If we can identify the practical barriers to engagement, and address people's concerns through effective communication, we will build a system able to embrace advances and improve health outcomes for all patients. "

Education and engagement need to be driven by, as well as for, the groups in question. Katherine Mathieson, CEO of The British Science Association, has extensive experience working with minority communities. "I often hear calls for more 'representation', but that's not the problem," she says (indeed, the BAME population is actually #by-ethnicity">over-represented among the NHS workforce). "Instead, we need to ask different questions; to be led by local communities as well as launching centrally funded 'outreach' programmes. "
Be slow to be fast
So why not start immediately? First, because the health and care sectors are complex: strictly evidence-based, highly regulated, and often decentralised. The NHS, however coordinated it may be, is an ecosystem of hundreds of organisations. While transformations have historically suffered from rigid centralised planning and mass rollout, some preparation is needed.

Secondly, we are already in the midst of excessive change and the fatigue it brings with it. Even healthcare data, despite its value, can be hard to manage and even harder to build public trust in. Without firm foundations, any rush to innovate may lead to more problems than solutions.

There must be a period of reflection, where pockets of innovation (like accessibility and inclusive prescribing) can be expanded, and new ideas sifted. This is one aim of the ' NHS Reset' campaign being championed by NHS Confederation, The Health Foundation, and England's Academic Health Science Networks.

As Richard Stubbs, CEO of the Yorkshire and Humber AHSN, and one of the Reset campaign leads explains, "We have seen rapid and fundamental changes in the way the health system functions. Now we have a time-limited opportunity to evaluate these changes and sustain the ones we expect to deliver value in the future before we slip back into previous ways of delivering care. "
Cause for optimism?
Despite the clear and present challenges to health equality, there is cause for hope. Mobile approaches are widening access, reducing costs, and improving user experience. Clinical commissioning is being enhanced through real-time system integration and information sharing. Across health and care, innovators are working quickly, building locally before scaling nationally, and investing in essential education and community engagement.

If we are to see the dawn of truly universal healthcare coverage, leaders in the NHS and globally will need to take time to balance the trade-offs, learn from the past, and share those lessons with each other.

"I'm more optimistic than I've ever been," says Hassan Chaudhury, Digital Health and Care Lead at Healthcare UK in the Department for International Trade. "There is so much digital innovation in the UK, from NHS organisations to start-ups to well established private companies. If we harness it in the right way, we can revolutionise patient care forever. "
#whjfeature #healthcareuk #benmarshall #digitalinnovation #coronavirus

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Can digital innovation reduce healthcare inequalities?

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Can digital innovation reduce healthcare inequalities? By Ben Marshall - Healthcare UK - World Healthcare Journal Covid-19 overshadows all our lives. But just because we are battling the same storm does not mean we are all in the same boat.

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What is this article about?
Hungarian healthcare workers had to sign a new contract by March 1st in order to be able to continue working in public care. The new contract contains strict conditions and a lower salary for some due to new overtime rules and the banning of second jobs, which is why many working in the sector have refused to sign it.

Why it is interesting?
More than 5500 healthcare workers including doctors and nurses left the public healthcare sector in Hungary this week, which causes serious damage to the health care system middle of the pandemic. Many departments including intensive care units unable to function anymore and close their doors.

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Hungarian healthcare workers had to sign a new contract by March 1st in order to be able to continue working in public care. The new contract contains strict conditions and a lower salary for some due to new overtime rules and the banning of second jobs, which is why many working in the sector have refused to sign it. According to the national director-general of hospitals, 95 percent of workers signed the documents.
Parliament approved the bill for a major wage hike for physicians last October. The new law grants a 120% salary increase to doctors in Hungary in three steps, reaching its maximum in January 2023. The law also criminalizes gratuities offered as bribes and sets a limit on the value of non-cash gifts from patients to doctors at five percent of the monthly minimum wage.
Hungary's New Pay Scale for Doctors a Step Closer to Western Healthcare Salaries
But doctors working in public care have to accept a number of conditions in exchange for the higher salary and must also sign a new contract with the government. Other healthcare workers such as ambulance workers and nurses also have to sign the contract although they are not receiving any wage hike, only the new list of strict conditions. As a result, healthcare workers lose their civil service status with the introduction of a new special one called 'health service relations.' Those who didn't sign the papers by the 1st of March are not able to work in public hospitals and specialist clinics.

As we previously reported, the content of the new contract has been causing major tensions across Hungary among healthcare workers, mainly because it is still unclear what will happen to the extra compensation given to doctors on top of their basic salaries. Additionally, doctors will receive less hourly wages during on-call shifts, at night, on weekends, and on holidays than during normal working hours. This, for many, means a step back from the level of promised salary increase, for some it would even negate it.
Many Doctors Refuse to Sign New Contract With Gov't
The current situation is particularly worrying because the third Covid wave in Hungary is on the rise, with more and more people being hospitalized. If health workers choose en masse not to continue their work, patient care can quickly reach the limits of its capacity.

Meanwhile, there are several reports of healthcare workers who refused to sign the contract just hours before the deadline.

17 nurses and three doctors working in the intensive care department of Budapest's Szent Imre Hospital handed in their resignation, reports 444.hu

The department has an important job: it is responsible for providing care for covid-intensive, non-covid-intensive, and covid-suspected patients.

"There's not enough equipment, or people, and no money. You have to beg for basic things like rubber gloves, FFP-2 masks, protective clothing. According to the management, everything was fine with these," one of the nurses who resigned said, justifying the staff's decision. She said they had already reported their problems to the hospital management last year, however received nothing but promises.

In a follow-up statement, Szent Imre Hospital said that the vast majority of their staff - doctors and nurses - had already signed the new contract of employment. Just like in other healthcare institutions, Szent Imre Hospital had problems only in the busiest care sector. Uninterrupted patient care is still ensured with in-house redeployment, they emphasized.

But it is not only Szent Imre Hospital where the en masse resignation is causing problems in patient care.
New Law Granting Historic Pay Raise to Doctors Includes Strict and Severe Conditions
According to another report by hvg.hu, only three of the 15 doctors signed their new contracts in the internal medicine department No. 2 of the Jahn Ferenc South Pest Hospital, thus the department has become unable to function.

This places a huge burden on the other internal medicine departments of the institution, the director-general of the hospital wrote in the letter informing Hungary's National Public Health Center of the situation.

The specialist clinic found in the town of Aba also had to suspend its operation because the seven minority municipal owners of the operating company prevented the head of the clinic from signing his new contract, news site Telex writes.

A letter sent to the staff of Tatabánya's Szent Borbála Hospital was also leaked, informing them there will be no night shift in the emergency department of the institution on Monday. All on-call specialists have to provide care for their patients in the ICD.

Employees of Szent-Györgyi Albert Clinical Center of the University of Szeged announced in an open letter that they had signed their new contracts, but if the management of the University and the Clinical Center did not fulfill their requests by May 31st, they would terminate their employment en masse.

Cardiologist Fidesz Mayor harshly criticizes new conditions

Due to the new, strict conflict-of-interest rules in the contract, the wife of András Csaba Dézsi, the Fidesz Mayor of Győr who is also a Chief Physician, is also leaving healthcare after 15 years of joint work, Dézsi announced on Facebook.

Dézsi, who did not give up his profession as a cardiologist after being elected mayor, harshly criticized the new legislation, calling the move a "disgrace," and told tabloid Blikk that his wife had not signed the new contract offered to her, which would downgrade her, and would rather teach at the university.

At least 15-16 points of the law regulating the new service relations of healthcare workers are problematic, said Dézsi.

According to Dézsi, banning second jobs for workers is a bad idea, as this is why a significant proportion of highly knowledgeable people are likely to move into the private sector. However, many serious operations cannot be carried out there, he said.

Dézsi believes that only the government can correct these mistakes, and he is sure it will.

National hospital chief: Almost all health workers have signed new contract

More than 95 percent of Hungary's health-care workers have signed their new contract establishing their new legal status, the national director-general of hospitals said on Tuesday.

Hungary's health-care system employs more than 110,000 people, most of whom have accepted their new contracts, Zoltán Jenei told a press conference, adding that as many as 96 percent of them could end up signing the contract.

Jenei said the new legal status of health-care personnel would help maintain or even improve the quality of health care across the country.

Jenei expressed his respect for the health-care personnel who had decided to remain in the public health-care sector during the coronavirus pandemic.
Featured photo illustration by Zoltán Balogh/MTI

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Many Healthcare Workers Refuse to Sign New Contract, Leave Public Healthcare

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Hungarian healthcare workers had to sign a new contract by March 1st in order to be able to continue working in public care. The new contract contains strict conditions and a lower salary for some due to new overtime rules and the banning of second jobs, which is why many working in the sector have refused to sign it.

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This article is interesting because it looks how large numbers of families have had their social care packages reduced by local authorities  and the impact this has had on their lives and families.

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Latest Coronavirus news, comment and analysis from the Guardian, the world's leading liberal voice

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This article highlights the inadequate level of infrastructure available at maternity units in Ireland.
Promised government funding has not materialised which has led to ongoing failings in the areas of training, governance, facilities and equipment.
This is interesting because, despite many high profile cases of litigation against the HSE due to failings in maternity care, things haven't improved much.

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The Government has been urged to fully fund the national maternity strategy after a report showed only 11 per cent of the money originally promised has been provided.

Fifteen of the State's 19 maternity units are operating in substandard physical environments, the report by the State's health watchdog also found.

The Health Information and Quality Authority (Hiqa) said it was told by the HSE it would cost €75 million to fund the 10-year strategy, which was launched by Leo Varadkar in 2016. However, just € 8.5 million was provided in the first three years.

Róisín Molloy, whose newborn son Mark died in 2012 as a result of failings in Portlaoise hospital, said babies would continue to die unless a new government properly funds the strategy.

She pointed to a finding in the report that many maternity unit staff were not being trained in the use and interpretation of baby heart monitoring equipment. Where babies are injured at birth, an alleged failure to interpret this data is a "constant theme" in subsequent litigation, she pointed out, and was a major contributor to the rising cost of obstetric claims for the State.

Mr Varadkar, when Minister for Health, had promised ringfenced funding for the strategy, which never materialised, she said. Further, the HSE last year allocated just €1 million for it, instead of the €8 million required, "when it knew this report was saying the strategy had to be fully funded".

The report states: "Hiqa believes that a comprehensive, time-bound and fully costed implementation plan for the strategy is vital to both the strategy's success and safer maternity services between now and 2026."

The National Women's Council of Ireland called on all newly elected politicians to make fully funding the strategy a "red line issue" in programme for government negotiations.

Additional funding

Responding to the report, the Department of Health said "additional development funding" of €1.5 million has been allocated for the strategy in 2020, which will be used to further roll-out a new model of care. It said it would engage with the HSE to ensure a plan is developed to implement the recommendations.

Only the maternity units in Cork, Cavan, Drogheda and Wexford are found to be substantially compliant with standards on physical infrastructure, with the remaining 14 units - including the three big Dublin maternity hospitals - judged to be in need of significant upgrading and refurbishment, according to the report.

A low uptake by staff of training in specialist areas, and the lack of maternity networks within hospital groups, are identified as shortfalls that need to be addressed.

Two maternity units - University Hospital Kerry and St Luke's, Kilkenny - are identified as having particularly high levels of non-compliance with standards. Among the problems identified are leadership and government issues, as well as arrangements around staffing, training and audit. Many of these issues were being addressed when Hiqa carried out follow-up audits.

Despite a long-standing promise that foetal ultrasounds would be provided at every maternity unit, these scans remained unavailable at five locations as the report was being compiled.

Up to 20 per cent of consultant posts in many medical specialties remain unfilled and many smaller maternity units are heavily reliant on junior doctors to provide 24/7 services, according to the report.

Overall, Hiqa reported high levels of compliance with its national standards. Most maternity units, for example, had arrangements in place to identify women at higher risk of complications and to transfer them as appropriate. And all units had emergency arrangements in place, with response teams available 24/7.

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Most maternity units operating in substandard physical environments

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The Government has been urged to fully fund the national maternity strategy after a report showed only 11 per cent of the money originally promised has been provided. Fifteen of the State's 19 maternity units are operating in substandard physical environments, the report by the State's health watchdog also found.

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This article is interesting because it describes a surprising but promising study that showed an unusually high rate of people naturally suppressing HIV. This could, according to the article, lead to advancements in understanding the mechanisms by which HIV could be cured or a vaccine could be manufactured.
I also found it interesting that the study in question took place in the DCR, which is believed to be the in the region that the virus originated. It is interesting to compare natural immunity in various regions and consider what factors contribute to higher resistance.

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Scientists carrying out HIV research in the Democratic Republic of Congo have discovered a rare group of people who could potentially unlock new treatments to tackle the virus.

Known as HIV controllers the group tested positive for HIV antibodies but they had a low to non-detectable viral load without the use of medication.

The head of Abbott's global viral surveillance programme, Mary Rodgers, told BBC World News that typically less than 1% of people with HIV are able to suppress the virus naturally, so when they found up to 4% of people who were able to do this, the scientists were shocked.

She explained that the study was serving as a springboard for further research.

"When we first started to see the data coming in from the study we were surprised, but we were also elated. This could mean that this is something that we can actually cure," she said.

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DR Congo HIV study: 'New hope in search for cure'

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Scientists carrying out HIV research in the Democratic Republic of Congo have discovered a rare group of people who could potentially unlock new treatments to tackle the virus. Known as HIV controllers the group tested positive for HIV antibodies but they had a low to non-detectable viral load without the use of medication.

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This article highlights the outdated IT infrastructure in Ireland's Health System. The system recently crashed and people were asked to do their own contact tracing. It is terrible that it took a pandemic, where it is most needed, for the government to realize the systems need to be updated.

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The lack of effective IT systems has slowed down the work of public health specialists, impacting Ireland's ability to break the chains of transmission of SARS-CoV-2. Niamh Cahill reports in the first of a series on IT in healthcare
Information technology (IT) has a pivotal role in healthcare internationally. Modern health systems cannot function effectively without it. As such, public health IT systems have come under sharp focus since the onset of the Covid-19 pandemic. Ireland's response to the global emergency has not been helped by the fact that public health medical IT infrastructure was significantly underfunded for decades.

A year into the crisis, this situation has not improved, despite a public health IT system collapse during the height of our third wave. Our public health specialists have admirably managed a pandemic response with what has been described as 'Stone Age' IT systems. Ireland has no public health outbreak management system or relational databases, for example.

Such IT systems could save millions of euro, reduce the workload of over-stretched public health departments, and improve our overall pandemic response. It has been argued that if adequately resourced - including the provision of efficient IT systems - regional public health teams could increase their work in breaking chains of virus transmission, resulting in fewer Covid-19 cases and potentially a reduction in 'lockdown' measures.
Old infrastructure
According to Dr Mary O'Riordan, Specialist in Public Health Medicine and working in health protection and infectious diseases at the Health Protection Surveillance Centre (HPSC), the computerised infectious disease reporting system (CIDR) is 20 years old. A member of the IMO public health committee, Dr O'Riordan said that only minor system updates have occurred in the lifetime of the CIDR.

The CIDR was never designed for investigation and control of infectious diseases, but mainly to upload disease notifications.

"The burden of the pandemic showed that the system needed significant updating. There was a system collapse during Christmas 2020 due to the inability of CIDR to cope with the increased numbers of cases of Covid," said Dr O'Riordan.

This came after a system collapse in October when over 2,000 people were asked to do their own contact tracing due to a rise in virus cases that overwhelmed the contact tracing system. Preliminary work, Dr O'Riordan added, had commenced on the establishment of an incident and case management system months prior to the pandemic but this was halted due to the crisis.

She explained that having an incident and case management IT system is a critical part of the public health response to health threats. It was noted as a key area of proposed investment by the Crowe Horwath report on public health, published by the Department of Health in 2018. Many of the recommendations in the report have yet to be implemented.

"An incident and case management system would also have included contact tracing modules which would have superseded the need for a separate contact tracing IT system that had to be set up as an emergency measure to respond to the pandemic. It would also have meant that linkage between cases, contacts and immunisations could be done with more ease and accuracy for assessing trends and response effects," she said.

The only IT system established since the pandemic began is the contact record management (CRM) system. According to Dr Ina Kelly, Specialist in Public Health Medicine and Chair of the IMO public health committee, the CRM system is constantly undergoing improvements. But it "is anything but user-friendly".

"It was designed by people who don't do infectious disease epidemiology. It uses meaningless terms. We've got used to using it and we're glad of the support... but it links very little to anything."

The system has yet to be put on a clinical and legal governance foothold, which needs to occur to avoid data breaches, argued Dr Kelly. As well as the CRM, public health specialists have computers with networks and servers,
many of which are "very rusty and slow", according to Dr Kelly.

This brings us back again to the failure to recognise the needs of public health medicine by the State...

"We use Excel sheets for our epidemic curves...There is no relational database, no outbreak management system. We have been talking about these since the year dot, but they have not been forthcoming yet."

The lack of effective IT systems has slowed down the work of public health specialists. Outbreak management is a complex task, according to Dr Kelly, and the absence of satisfactory systems makes their work slower, harder, more time consuming and haphazard. Instead, outbreaks are being managed "in our heads, in bits of paper, emails, Excel sheet lists; there is no system in place", she said.
Immunisation
Outbreak management and disease control systems are not the only absent IT supports that have affected our pandemic response. The precious time of over-worked public health specialists was taken up by having to contribute to the development of a Covid-19 vaccination recording system.

National immunisation records are still, in part, paper-based and held on different electronic databases depending on what service provides the vaccination and for what disease, said Dr O'Riordan.

"This is despite many years of lobbying by public health medicine to have resourced a singular national immunisation system. Again, having to build a bespoke system for Covid vaccination recording was an additional burden at a time of an emergency. Had there been an established electronic system for immunisation recording in the State, this would have meant the 'day-to-day' system could have been used instead of having to build another one during an emergency.

Most European member states have both central electronic immunisation recording and incident and case management systems in place.

"This means that their ability to respond because of the ease of transfer of information between the necessary stakeholders and elements of response would be more efficient. Timeliness and accuracy are key elements to aid the response to any threat mitigation, and in this case the response to a pandemic," said Dr O'Riordan.

"Although credit has to be given to those colleagues who have worked tirelessly to build new IT systems to support contact management systems and vaccine roll-out, large scale systems to support the provision of public health medicine for the State should have been established prior to the pressures of a pandemic, when due consideration to the complexities of such systems could have been given.

"This brings us back again to the failure to recognise the needs of public health medicine by the State and therefore the lack of provision of resources to ensure that Ireland's health security can be maintained," she argued.
Australia
Irishman Dr Niall Conroy, a Public Health Director and Consultant based in Australia, said public health in Australia is "a completely different animal" to public health in Ireland. He argued that politics has played a large role in the level of investment and supports provided to public health departments in Ireland.

"I think the real underlying difference is how the political establishment views the usefulness of public health. Australia is far from perfect in this regard, but they can at least see beyond a political cycle."

He said in Queensland, where he works, there is a "fairly sophisticated outbreak management IT system that has been designed from within and with our input".

"Whereas my colleagues at home have had a system foisted upon them," he said in reference to the CRM system.

He criticised the lack of public health leadership on the national public health emergency team (NPHET), unlike in Australia where their contribution is valued.

"There are a lot of very good people on NPHET. But the reservoir of outbreak expertise in Ireland is within the public health units. Yet, there is only one public health doctor on NPHET. In the Australian equivalent, more than half are from public health units."

"It's sad to hear colleagues back home telling me they have no way to formally feed their ideas into NPHET. That's in stark contrast to Australia where our input is actively sought and feedback is taken on board. In short, our expertise is recognised and valued in Australia. Whereas it looks like my colleagues back home are regarded as mid-level technicians, rather than as leaders."

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'Stone Age' systems hamper Ireland's public health specialists

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The lack of effective IT systems has slowed down the work of public health specialists, impacting Ireland's ability to break the chains of transmission of SARS-CoV-2. Niamh Cahill reports in the first of a series on IT in healthcare Information technology (IT) has a pivotal role in healthcare internationally.

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Why is this interesting? Norway have now opened a medication free ward. This is an interesting way forward. Should health care professionals try to enable patients to cope in a community setting, therefore is it not a step backwards to have them recover drug free in hospital, should there not be community based programmes to enable patients to recover around familar settings and adjust to daily life. Due to a lack of health care proffessionals patients may not get the support one needs in these wards.

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Most people with psychosis take powerful drugs to keep delusions and hallucinations at bay - but the side-effects can be severe. In Norway, a radical approach is now on offer via the national health system for patients who want to live drug-free.

Malin was 21 when her life began to unravel.

She had struggled with severe depression and low self-esteem since she was a teenager.

Then a voice inside her head started telling her she was fat and worthless - and that she should kill herself.

"He became very angry. He kind of isolated me because he got a lot of power. Eventually I also starting seeing things, like tentacles coming out of the walls," she says.

Malin left her small home town near the fjords of northern Norway and went off to university. But it wasn't long before she had a complete breakdown that left her unable to get out of bed. Her family came to pick her up and soon she was committed to a psychiatric unit where she stayed for a year. It was the first of several long stays in psychiatric hospital wards where powerful anti-psychotic medication was the only treatment on offer.

"I was so full of drugs, my mind was just a blur. I just sat there passively watching my life go by with no connection to my emotions or feelings.

"And it's kind of been the same thing over and over. I've sought help and what they can give me is medication. And nothing really got any better.

"It's quite devastating. You just really want to get well. And people tell you that now this is your life, you should be content. And I cannot be content with this life."

Malin's experience with psychiatric medication isn't unusual. Although many people with psychosis find anti-psychotic drugs enable them to live a normal life, it is thought around 20% of patients do not respond well. The side effects can be life-changing - extreme fatigue, weight gain, increased cholesterol and diabetes.

In Norway, concerns about the overall benefit of these drugs are compounded by a long-standing problem with forced treatment, which is more common here than in many other countries according to the limited number of international comparisons that exist.

The UN Committee Against Torture has singled out Norway's use of forced isolation in mental health facilities as something that must change.

Like Malin, Mette Ellingsdalen was given anti-psychotic drugs during a period of 13 years when she suffered severe depressions - as a result of bipolar disorder - and was unable to care for herself. Unlike some of her fellow patients, she wasn't physically held down and injected with the drugs, but she still felt coerced; if she had refused the medication, she wouldn't have been admitted to hospital.

"I did have a big crisis that brought me into the system, things from my childhood that I struggled with strongly. The medication numbed some of the symptoms, but they also numb your own power and your own ability to deal with yourself. I lost my own story somehow," she says.

Eventually, after five years of trying but failing to live without medication, she was able to successfully taper off her drugs and in 2005 she joined the movement to change Norway's mental health system and is now chair of the patient user group, We Shall Overcome.

"The most easy way to reduce force is to give people a choice, to give them a treatment they can say yes to," she says.

Years of advocacy work by people like Mette paid off in 2016 when regional health authorities were ordered by health minister Bent Hoie to provide medication-free treatment wards. While medication-free treatment is available in some other countries, Norway became the first country in the world to embed it as an option in the state-run mental healthcare system.

At the time, Dr Magnus Hald was director of mental health and substance abuse at the University Hospital of northern Norway based in Tromso, Norway's gateway to the Arctic. He'd worked for years in units where a lot of drugs were used and was keen to explore an alternative treatment - so he took on the job of running the hospital's new drug-free department.

"To me, the most important thing is that people are allowed to try different kinds of possibilities," he says.

"You have to tell the truth to the patient about how the medication works and what you know about it. And it seems that in co-operation with the pharmaceutical industry, they've told people things that are not completely correct about how medications work and what the risks are. For instance, there is a myth that there is some kind of chemical imbalance in the brains of people with serious mental problems [and] there is actually no research that really supports this."

Many of the patients at the unit in Tromso are tapering off drugs, which takes time and care.

"For most of the patients that we have, it works," says Hald. "Some patients will never go back to using any kind of drugs. And some patients might go back to drugs after some time and some patients may just reduce their doses."

Malin, now 34, is a patient at the unit.

She spends several weeks at a time in Tromso and then goes home for months in between, back to her dog, Jarek. It's not easy - she lives alone and has little mental health support nearby so her progress is slow - and the voice she hears has not completely disappeared.

Malin now mainly uses medication to calm her at night. She's going through intensive therapy while at the unit, an option she says she was never offered while on medication. Art has been central to her recovery.

"I'm trying to reconnect with my emotions instead of dulling down the symptoms. We explore what this voice wants and what do I need for him to stop?"

Malin now feels strong enough to think about working, hopefully in Norway's husky dog sledding tourism industry.

"I feel like for the first time ever I'm starting to find myself. I'm starting to build up my self-esteem and I can dare to feel some hope for the future, and that is pretty amazing."

Stories like Malin's are starting to be heard - and really listened to. But medication-free treatment is controversial in Norway.

For many patients, anti-psychotics are vital. Claudia (not her real name) now in her 20s, first became suicidal and delusional as a teenager. Part of her illness was believing the anti-psychotics she was offered were poisoned. So she was held down and forced to take them - and got better.

"But then after a period of stress, again, I got really sick, and had to start again. And now I've sort of come to terms that I need medication to at least keep my head above water.

"I don't really like the word 'normal', but I feel really good when I'm on medication. I feel like I can contribute during my studies, and hang out with friends and stuff like that, while when I'm off them, my functionality is just declining and I feel more stressed and chaotic and weird."

Critics say the medication-free movement is driven by ideology rather than evidence. Dr Jan Ivar Rossberg, a psychiatrist who lives and works in Oslo, likens it to failed experiments in the 1960s and 70s when patients were given free rein in therapeutic communities, encouraged to take LSD and regress to childhood. This methodology was called "anti-psychiatry".

"History has shown us that this approach doesn't work, so we have stopped using it. We don't have treatment approaches shown to be effective without medication," he says.

He points to evidence that shows the best outcomes for people with psychosis involve medicating through the initial acute phase, when delusions and hallucinations are strongest, and staying on the drugs for around two years before trying to taper down to a lower dose.

Magnus Hald is not convinced by this. He is about to start a research project to track patients in the years after they've been at the medication-free unit in Tromso. There have been no suicides among his medication-free patients, but so far the approach lacks a strong evidence base.

"The idea of evidence-based medicine is difficult within mental health as a whole, although it's of course an aim that we should have," he says. "At the same time, we know that diagnoses in psychiatry are just a classification system. Even though you give a person a diagnosis of schizophrenia, you do not see any malfunction in the brain besides what you experience by engaging in a conversation with the person. You cannot see anything on the CT or the MRI images."

There is controversy also about how the medication-free programme could develop in future.

So far, patients in the acute stage of psychosis cannot be referred to medication-free units. User groups are hoping to change that, arguing that this phase often passes on its own if people can be in a place of safety and support while they weather the storm.

But Dr Tor Larsen, a specialist in acute psychosis, worries about this idea. He points out that most patients with untreated psychosis do not realise they are ill so will not agree to be treated with or without drugs - and drug-free units operate on a voluntary basis.

"It's almost by definition a part of having hallucinations or delusions that you don't think you're sick, if you are in contact with God or if you think you are the reborn Napoleon," he says. "So in cases where people have devastating psychosis, it might be important to give them treatment even on an involuntary basis."

Studies show many people with untreated psychosis end up living on the streets, he says, and that about 30% of patients with untreated psychosis commit crimes or are violent towards relatives and others.

There is also an increased rate of homicide.

He cites as an example the random murder of 67-year-old Bjorg Marie Skeisvoll Hereid in a graveyard in 2019 by a psychotic man with an axe. The murder shook the quiet town of Haugesund in the south-west of Norway and made national headlines.

The murderer wasn't on a drug-free treatment programme, but he had chosen to come off his medication, and was also using illegal drugs. The tragic incident sparked debate about a change in the law made in 2017, which states that patients who are able to make decisions about their own treatment can no longer be involuntarily committed or forced to take medication, unless they pose an imminent risk. Critics say this has made it more difficult for doctors to commit potentially dangerous people to hospital for treatment.

Hakon Rian Ueland, 54, one of the campaigners who helped bring about medication-free treatment in Norway, believes that this conversation about danger hides an agenda to shelter society from the often challenging behaviour of people going through psychosis. "They are putting forward an agenda to sedate people," he says, adding that symptoms that alarm neurotypical people may be important for the person experiencing them. "When you go through psychosis it can be very dramatic."

He says there are still bureaucratic and cost barriers to people who want to access the medication-free services.

"The whole movement needs more oversight," he says. "We need a review of what has happened so far. I would like to see someone who goes in from outside the system and has the power to ask for change."

Psychiatrists and patients around the world are watching what happens in Norway, where the government has taken decisive action to try and improve the lives of psychotic people by giving them more power over their lives. Globally, there's a reassessment of the way people with mental illness are treated and a will to reduce coercion.

Medication-free treatment could be just another therapeutic fad - or it could have the power to change psychiatry for good.

In Croatia, thousands of people with mental illness live in institutions. The process of moving patients out of residential care and into the community happened decades ago in many European countries. But Croatia has resisted change - except in one region in the east of the country, close to the Serbian border.

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How Norway is offering drug-free treatment to people with psychosis

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Most people with psychosis take powerful drugs to keep delusions and hallucinations at bay - but the side-effects can be severe. In Norway, a radical approach is now on offer via the national health system for patients who want to live drug-free. Malin was 21 when her life began to unravel.

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This article explores a new technology which is being developed as a less invasive way of diagnosing and treating colon cancer which is one of the most common forms of cancer in the world. It is interesting that a new light based technology will be able to assist many doctors ansd surgeons in detecting during the early stages which could result in less treatments and surgeries for the patient.

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Scientists based in Cork have developed a more effective and less invasive way to diagnose and treat colorectal cancer, which is the third most common type of cancer in the world and the second most deadly.

The advance has been achieved by researchers at Tyndall National Institute in Cork in partnership with clinicians at Mercy University Hospital (MUH) and Cork University Hospital (CUH).

They have created a tool for non-invasive surgical guidance and early disease detection using biophotonics technology; a light-based instrument that senses and differentiates tissues including tumours more accurately and faster.

The team's research has been published in the scientific journal Nature, and proves the use of biophotonics can help to radically improve health outcomes for patients as it is less invasive and provides more comprehensible information to clinicians and surgeons in real time - particularly in the area of colon cancer.

Pre-clinical and clinical studies with patients who have gastrointestinal diseases and oral cancer are due to commence in the MUH and CUH later this year.

Marcelo Saito Nogueira from the biophotonics team said clinical interventions have been significantly improved by recent advances in devices for diagnostics and surgical guidance. Most used imaging technologies provide key indications "only detectable at a late stage in the disease".

He added: "The tools we are developing will be more beneficial as they identify and locate disease at an earlier stage based on molecular changes, If accurately detected, the disease can be fully treated in less procedures and the risk to the patient and number of cancer surgeries would be reduced."

The team are using optical spectroscopy and imaging techniques that are promising "molecular-sensitive tools" with potential to monitor diseases and guide surgical procedures by providing a non-invasive, fast and in situ interrogation of biological tissues.

"We have shown that by selecting fine wavelengths of light it is possible to differentiate the molecular structure of cancerous versus non-cancerous cells," he explained.

Colon cancer fatalities worldwide

These techniques can be cost-effective and integrated into existing clinical tools, which enhances their potential to improve current healthcare and also makes them commercially attractive, said Mr Nogueira. "We also look forward to collaborating in the future with one of the numerous medical device companies located in Ireland. "

Colon cancer accounts for more than 9 per cent of all cancer deaths worldwide and this is estimated to increase by 71.5 per cent by 2040.

The biophotonics team at Tyndall, which is based in UCC, is researching non-invasive techniques that are more accurate and faster than conventional detection methods. They are now developing a probe for colon cancer detection during colonoscopy, which can investigate additional types of biomolecules located at different tissue depths.

This will help surgeons to take biopsies at the right places - as they have no guidance as to where to request a biopsy - which will obviate the need for multiple biopsies. It could also help identify more subtle abnormalities such as premalignancies invisible through colonoscopes and medical devices.

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Breakthrough by Cork scientists on colon cancer detection

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Scientists based in Cork have developed a more effective and less invasive way to diagnose and treat colorectal cancer, which is the third most common type of cancer in the world and the second most deadly. The advance has been achieved by researchers at Tyndall National Institute in Cork in partnership with clinicians at Mercy University Hospital (MUH) and Cork University Hospital (CUH).

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Minister Feighan welcomes the approval of EU drugs strategy. In this proposed strategy, new methods of addressing drug related harms are utilized. They plan to do this through more of a health-led medical model approach with less coercive or criminal sanctions. More progressive drug policy on the horizon?

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Under drug supply reduction/enhanced security, the strategy targets all aspects of the illicit drug market, and includes the prevention of, dissuasion from and disruption of drug related crime, in particular organised crime, through judicial and law enforcement cooperation, intelligence, interdiction, confiscation of criminal assets, investigations and border management.

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Minister Feighan welcomes the approval of the EU Drugs Strategy 2021-2025

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Under drug supply reduction/enhanced security, the strategy targets all aspects of the illicit drug market, and includes the prevention of, dissuasion from and disruption of drug related crime, in particular organised crime, through judicial and law enforcement cooperation, intelligence, interdiction, confiscation of criminal assets, investigations and border management.

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This article caught my eye as it discusses a leaked UK government memo about potential reforms of the NHS. The proposal would effectively end the statutory independence of the NHS and bring it back under the governance of the Minister for Health and his department. This has serious implications for funding/ access and even what form of health care service will be offered in the future. Is this the end of the NHS as we know it?

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www.instituteforgovernment.org.uk is using a security service for protection against online attacks. This process is automatic. You will be redirected once the validation is complete.

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www.instituteforgovernment.org.uk is using a security service for protection against online attacks. This process is automatic. You will be redirected once the validation is complete.

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A new app is being launched to help young people who suffer with schizophrenia. It will allow participants to manage their conditions and keep in touch with peers, doctors and past patients. It is not used to treat the illness but instead help with recovery.

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A new mobile phone app is to be rolled out to young people suffering from schizophrenia and other psychoses this week in a €1.5 million trial to measure how social technology can enhance recovery.

The five-year study being undertaken at NUI Galway happens to have come at a crucial juncture - ongoing Covid-19 restrictions have imposed particular challenges on those suffering complex mental health issues, aggravated by social isolation.

Based on an Australian success story, the newly designed MOST app will allow young participants not only to manage their conditions in real time, but to maintain contact with a core group including peers, doctors and past patients.

"What we really want to know is if we can deliver this in an Irish context," said Dr Gary Donohoe, Professor of Psychology at NUI Galway, who is overseeing the project.

"What we have noticed is that young people are much more comfortable texting or using social media than they are at picking up the phone."

Although not a treatment for the illness, the app management approach could form a key part of recovery.

Psychoses typically affects younger people from their teenage years up to about 30 (two-thirds of all patients), while older people are often those who have simply never received treatment.

The condition affects the way the brain processes information - those who suffer its effects can lose touch with reality and develop symptoms including hallucinations and delusions. This often means hearing voices or believing people are intent on harming them.

At any one time in Ireland there are about 75,000 people with various psychoses, including about 45,000 with schizophrenia, one in five of whom might only ever experience one episode. In Ireland, the annual new case rate is about 32 per 100,000 people.

The study funded by the Health Research Board funded will eventually compare the recovery data of those who used with the app against those who did not.

Participants are to be drawn from new early intervention centres which have opened in Cork and Sligo, and a third due to open in Meath early next year. There they receive a variety of therapies and interventions as well as access to supported employment.

"We now know that if you can identify people earlier and engage them in a range of treatments in the community they do an awful lot better," said Dr Karen O'Connor, a consultant psychiatrist and National Clinical Lead of Early Intervention in Psychosis who has previously worked in Melbourne alongside the people who developed a similar app.

"Some people will find social interaction harder and we are hoping that they will find the app a less threatening way. For some people the online space is definitely a more comfortable space."

A key strength of the approach is communication through recovery. Both Prof Donohoe and Dr O'Connor explained that while much progress had been made in reducing stigma around mental health, this had not always extended to psychosis. Sufferers are often fearful of talking about their condition when recovering in day to day life, a limitation the app will help address.

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Irish-designed app in trial to help those with schizophrenia

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A new mobile phone app is to be rolled out to young people suffering from schizophrenia and other psychoses this week in a €1.5 million trial to measure how social technology can enhance recovery.

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This article discusses a study that was undertaken for a new drug for the treatment of obesity. The findings represent a major breakthrough for people with obesity and it discusses how this drug, semaglutide, may have major implications for health policy in the years ahead.

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One third (35%) of people who took a new drug for treating obesity lost more than one-fifth (greater than or equal to 20%) of their total body weight, according to a major global study involving UCL researchers.

The findings from the large-scale international trial, published today in the New England Journal for Medicine, are being hailed as a "gamechanger" for improving the health of people with obesity and could play a major part in helping the UK to reduce the impact of diseases, such as COVID-19.

The drug, semaglutide, works by hijacking the body's own appetite regulating system in the brain leading to reduced hunger and calorie intake.

Rachel Batterham, Professor of Obesity, Diabetes and Endocrinology who leads the Centre for Obesity Research at UCL and the UCLH Centre for Weight Management, is one of the principal authors on the paper which involved almost 2,000 people in 16 countries.

Professor Batterham (UCL Medicine) said: "The findings of this study represent a major breakthrough for improving the health of people with obesity. Three quarters (75%) of people who received semaglutide 2.4mg lost more than 10% of their body weight and more than one-third lost more than 20%. No other drug has come close to producing this level of weight loss -- this really is a gamechanger. For the first time, people can achieve through drugs what was only possible through weight-loss surgery."

Professor Batterham added: "The impact of obesity on health has been brought into sharp focus by COVID-19 where obesity markedly increases the risk of dying from the virus, as well as increasing the risk of many life-limiting serious diseases including heart disease, type 2 diabetes, liver disease and certain types of cancers. This drug could have major implications for UK health policy for years to come."

The average participant in the trial lost 15.3kg (nearly 3 stone); this was accompanied by reductions in risk factors for heart disease and diabetes, such as waist circumference, blood fats, blood sugar and blood pressure and reported improvements in their overall quality of life.

The trial's UK Chief Investigator, Professor John Wilding (University of Liverpool) said: "This is a significant advance in the treatment of obesity. Semaglutide is already approved and used clinically at a lower dose for treatment of diabetes, so as doctors we are already familiar with its use. For me this is particularly exciting as I was involved in very early studies of GLP1 (when I worked at the Hammersmith Hospital in the 1990s we were the first to show in laboratory studies that GLP1 affected appetite), so it is good to see this translated into an effective treatment for people with obesity."

With evidence from this trial, semaglutide has been submitted for regulatory approval as a treatment for obesity to the National Institute of Clinical Excellence (NICE), the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA).
About the trial
The Phase III 'STEP'* randomised controlled trial involved 1,961 adults who were either overweight or had obesity (average weight 105kg/16.5 stone; body mass index 38kg/m2), and took place at 129 sites in 16 countries across Asia, Europe, North America, and South America.

Participants took a 2.4mg dose of semaglutide (or matching placebo) weekly via subcutaneously (under the skin) injection; similar to the way people with diabetes inject insulin. Overall, 94.3% of participants completed the 68-week study, which started in autumn 2018.

Those taking part also received individual face-to-face or phone counselling sessions from registered dietitians every four weeks to help them adhere to the reduced-calorie diet and increased physical activity, providing guidance, behavioural strategies and motivation. Additionally, participants received incentives such as kettle bells or food scales to mark progress and milestones.

In those taking semaglutide, the average weight loss was 15.3kg (nearly three stone), with a reduction in BMI of -5.54. The placebo group observed an average weight loss of 2.6kg (0.4 stone) with a reduction in BMI of -0.92.

Those who had taken semaglutide also saw reductions in risk factors for heart disease and diabetes, such as waist circumference, blood fats, blood sugar and blood pressure and reported improvements in their overall quality of life.
About the drug
Semaglutide is clinically approved to be used for patients with type 2 diabetes, though is typically prescribed in much lower doses of 1mg.

The drug possesses a compound structurally similar to (and mimics) the human glucagon-like peptide-1 (GLP-1) hormone, which is released into the blood from the gut after meals.

GLP-1 induces weight loss by reducing hunger, increasing feelings of fullness and thereby helping people eat less and reduce their calorie intake.

While the STEP study has been through Phase I and II trials, assessing the 2.4mg doses for safety, in the Phase III trial some participants reported side effects from the drug including mild-to-moderate nausea and diarrhoea that were transient and generally resolved without permanent discontinuation from the study.

The international trial was funded by the pharmaceutical company Novo Nordisk.

* Semaglutide Treatment Effect in People with Obesity (STEP)

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diet and weight loss; obesity; diseases and conditions; fitness; dieting and weight control; nutrition research; behavior; addiction

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'Gamechanger' drug for treating obesity cuts body weight by 20 percent

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One third (35%) of people who took a new drug for treating obesity lost more than one-fifth (greater than or equal to 20%) of their total body weight, according to a major global study involving UCL researchers.

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Why interesting? This story shows there are different approaches to mental health treatment, suggesting a move from a biomedical model to a community-based approach.  But will it work, or rather, under what conditions will it work and how can we create that environment?

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Most people with psychosis take powerful drugs to keep delusions and hallucinations at bay - but the side-effects can be severe. In Norway, a radical approach is now on offer via the national health system for patients who want to live drug-free.

Malin was 21 when her life began to unravel.

She had struggled with severe depression and low self-esteem since she was a teenager.

Then a voice inside her head started telling her she was fat and worthless - and that she should kill herself.

"He became very angry. He kind of isolated me because he got a lot of power. Eventually I also starting seeing things, like tentacles coming out of the walls," she says.

Malin left her small home town near the fjords of northern Norway and went off to university. But it wasn't long before she had a complete breakdown that left her unable to get out of bed. Her family came to pick her up and soon she was committed to a psychiatric unit where she stayed for a year. It was the first of several long stays in psychiatric hospital wards where powerful anti-psychotic medication was the only treatment on offer.

"I was so full of drugs, my mind was just a blur. I just sat there passively watching my life go by with no connection to my emotions or feelings.

"And it's kind of been the same thing over and over. I've sought help and what they can give me is medication. And nothing really got any better.

"It's quite devastating. You just really want to get well. And people tell you that now this is your life, you should be content. And I cannot be content with this life."

Malin's experience with psychiatric medication isn't unusual. Although many people with psychosis find anti-psychotic drugs enable them to live a normal life, it is thought around 20% of patients do not respond well. The side effects can be life-changing - extreme fatigue, weight gain, increased cholesterol and diabetes.

In Norway, concerns about the overall benefit of these drugs are compounded by a long-standing problem with forced treatment, which is more common here than in many other countries according to the limited number of international comparisons that exist.

The UN Committee Against Torture has singled out Norway's use of forced isolation in mental health facilities as something that must change.

Like Malin, Mette Ellingsdalen was given anti-psychotic drugs during a period of 13 years when she suffered severe depressions - as a result of bipolar disorder - and was unable to care for herself. Unlike some of her fellow patients, she wasn't physically held down and injected with the drugs, but she still felt coerced; if she had refused the medication, she wouldn't have been admitted to hospital.

"I did have a big crisis that brought me into the system, things from my childhood that I struggled with strongly. The medication numbed some of the symptoms, but they also numb your own power and your own ability to deal with yourself. I lost my own story somehow," she says.

Eventually, after five years of trying but failing to live without medication, she was able to successfully taper off her drugs and in 2005 she joined the movement to change Norway's mental health system and is now chair of the patient user group, We Shall Overcome.

"The most easy way to reduce force is to give people a choice, to give them a treatment they can say yes to," she says.

Years of advocacy work by people like Mette paid off in 2016 when regional health authorities were ordered by health minister Bent Hoie to provide medication-free treatment wards. While medication-free treatment is available in some other countries, Norway became the first country in the world to embed it as an option in the state-run mental healthcare system.

At the time, Dr Magnus Hald was director of mental health and substance abuse at the University Hospital of northern Norway based in Tromso, Norway's gateway to the Arctic. He'd worked for years in units where a lot of drugs were used and was keen to explore an alternative treatment - so he took on the job of running the hospital's new drug-free department.

"To me, the most important thing is that people are allowed to try different kinds of possibilities," he says.

"You have to tell the truth to the patient about how the medication works and what you know about it. And it seems that in co-operation with the pharmaceutical industry, they've told people things that are not completely correct about how medications work and what the risks are. For instance, there is a myth that there is some kind of chemical imbalance in the brains of people with serious mental problems [and] there is actually no research that really supports this."

Many of the patients at the unit in Tromso are tapering off drugs, which takes time and care.

"For most of the patients that we have, it works," says Hald. "Some patients will never go back to using any kind of drugs. And some patients might go back to drugs after some time and some patients may just reduce their doses."

Malin, now 34, is a patient at the unit.

She spends several weeks at a time in Tromso and then goes home for months in between, back to her dog, Jarek. It's not easy - she lives alone and has little mental health support nearby so her progress is slow - and the voice she hears has not completely disappeared.

Malin now mainly uses medication to calm her at night. She's going through intensive therapy while at the unit, an option she says she was never offered while on medication. Art has been central to her recovery.

"I'm trying to reconnect with my emotions instead of dulling down the symptoms. We explore what this voice wants and what do I need for him to stop?"

Malin now feels strong enough to think about working, hopefully in Norway's husky dog sledding tourism industry.

"I feel like for the first time ever I'm starting to find myself. I'm starting to build up my self-esteem and I can dare to feel some hope for the future, and that is pretty amazing."

Stories like Malin's are starting to be heard - and really listened to. But medication-free treatment is controversial in Norway.

For many patients, anti-psychotics are vital. Claudia (not her real name) now in her 20s, first became suicidal and delusional as a teenager. Part of her illness was believing the anti-psychotics she was offered were poisoned. So she was held down and forced to take them - and got better.

"But then after a period of stress, again, I got really sick, and had to start again. And now I've sort of come to terms that I need medication to at least keep my head above water.

"I don't really like the word 'normal', but I feel really good when I'm on medication. I feel like I can contribute during my studies, and hang out with friends and stuff like that, while when I'm off them, my functionality is just declining and I feel more stressed and chaotic and weird."

Critics say the medication-free movement is driven by ideology rather than evidence. Dr Jan Ivar Rossberg, a psychiatrist who lives and works in Oslo, likens it to failed experiments in the 1960s and 70s when patients were given free rein in therapeutic communities, encouraged to take LSD and regress to childhood. This methodology was called "anti-psychiatry".

"History has shown us that this approach doesn't work, so we have stopped using it. We don't have treatment approaches shown to be effective without medication," he says.

He points to evidence that shows the best outcomes for people with psychosis involve medicating through the initial acute phase, when delusions and hallucinations are strongest, and staying on the drugs for around two years before trying to taper down to a lower dose.

Magnus Hald is not convinced by this. He is about to start a research project to track patients in the years after they've been at the medication-free unit in Tromso. There have been no suicides among his medication-free patients, but so far the approach lacks a strong evidence base.

"The idea of evidence-based medicine is difficult within mental health as a whole, although it's of course an aim that we should have," he says. "At the same time, we know that diagnoses in psychiatry are just a classification system. Even though you give a person a diagnosis of schizophrenia, you do not see any malfunction in the brain besides what you experience by engaging in a conversation with the person. You cannot see anything on the CT or the MRI images."

There is controversy also about how the medication-free programme could develop in future.

So far, patients in the acute stage of psychosis cannot be referred to medication-free units. User groups are hoping to change that, arguing that this phase often passes on its own if people can be in a place of safety and support while they weather the storm.

But Dr Tor Larsen, a specialist in acute psychosis, worries about this idea. He points out that most patients with untreated psychosis do not realise they are ill so will not agree to be treated with or without drugs - and drug-free units operate on a voluntary basis.

"It's almost by definition a part of having hallucinations or delusions that you don't think you're sick, if you are in contact with God or if you think you are the reborn Napoleon," he says. "So in cases where people have devastating psychosis, it might be important to give them treatment even on an involuntary basis."

Studies show many people with untreated psychosis end up living on the streets, he says, and that about 30% of patients with untreated psychosis commit crimes or are violent towards relatives and others.

There is also an increased rate of homicide.

He cites as an example the random murder of 67-year-old Bjorg Marie Skeisvoll Hereid in a graveyard in 2019 by a psychotic man with an axe. The murder shook the quiet town of Haugesund in the south-west of Norway and made national headlines.

The murderer wasn't on a drug-free treatment programme, but he had chosen to come off his medication, and was also using illegal drugs. The tragic incident sparked debate about a change in the law made in 2017, which states that patients who are able to make decisions about their own treatment can no longer be involuntarily committed or forced to take medication, unless they pose an imminent risk. Critics say this has made it more difficult for doctors to commit potentially dangerous people to hospital for treatment.

Hakon Rian Ueland, 54, one of the campaigners who helped bring about medication-free treatment in Norway, believes that this conversation about danger hides an agenda to shelter society from the often challenging behaviour of people going through psychosis. "They are putting forward an agenda to sedate people," he says, adding that symptoms that alarm neurotypical people may be important for the person experiencing them. "When you go through psychosis it can be very dramatic."

He says there are still bureaucratic and cost barriers to people who want to access the medication-free services.

"The whole movement needs more oversight," he says. "We need a review of what has happened so far. I would like to see someone who goes in from outside the system and has the power to ask for change."

Psychiatrists and patients around the world are watching what happens in Norway, where the government has taken decisive action to try and improve the lives of psychotic people by giving them more power over their lives. Globally, there's a reassessment of the way people with mental illness are treated and a will to reduce coercion.

Medication-free treatment could be just another therapeutic fad - or it could have the power to change psychiatry for good.

In Croatia, thousands of people with mental illness live in institutions. The process of moving patients out of residential care and into the community happened decades ago in many European countries. But Croatia has resisted change - except in one region in the east of the country, close to the Serbian border.

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How Norway is offering drug-free treatment to people with psychosis

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Most people with psychosis take powerful drugs to keep delusions and hallucinations at bay - but the side-effects can be severe. In Norway, a radical approach is now on offer via the national health system for patients who want to live drug-free. Malin was 21 when her life began to unravel.

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What this is about?
This news article is about working from home (parents and children).
Why it's important?
This shows some significance because it shows some insight into how people are coping, and how overwhelming it can actually be.
It also states some tips and guidelines you could follow to support your mental wellbeing.

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Teenage students in Covid isolation: ‘We’re all struggling’

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Remote learning, lockdowns and pandemic uncertainty have increased anxiety among adolescents

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Interesting article by David McWilliams on the possibility of pushing progressive drug policies post pandemic.

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Closing down the economy for a year in order to combat a virus comes at enormous economic, social and emotional cost, and yet this society can adjust and function under the most stressful conditions. It shows that we have the capacity to undertake a massive social experiment that no one before the pandemic thought possible.

If we can do this, consider all the other changes we could make. The pandemic should allow us to contemplate change. On almost every policy, from education and the Leaving Cert to housing and the rental crisis, as well as public health, we could ask ourselves: if we were to start again with a blank page, how would we design policy, free of inertia, vested interests and conventional thinking?

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David McWilliams: The economics of the drug trade and the case for legalisation

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Closing down the economy for a year in order to combat a virus comes at enormous economic, social and emotional cost, and yet this society can adjust and function under the most stressful conditions. It shows that we have the capacity to undertake a massive social experiment that no one before the pandemic thought possible.

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This article shows the effect the Covid-19 pandemic has had on young people and the long-term impact this could have. It also highlights the lack of support young people are receiving with regards to their mental well-being.

Why is it interesting?

It is nearly a year since the beginning of the pandemic and despite this, the government is still not providing adequate support for people whose mental health is suffering.

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More than half of parents and carers are concerned about the impact the Covid-19 pandemic is having on their children's mental health, according to new research.

A survey by the mental health charity YoungMinds found that 67 per cent of respondents are worried about how the pandemic will affect their children's long-term mental health.

This rose to 77 per cent for respondents whose children accessed mental health support in the three months prior to the virus taking hold in the UK.

Almost a third (29 per cent) of 1,854 adults surveyed say there isn't enough support for young people struggling with their mental health during the pandemic.

Among respondents whose children have received support through the NHS or other providers in the past three months, 25 per cent said they were no longer able to access it.

Parents and carers also reported an increase in anxiety and depression, a sense of loss and fear, difficulties coping with a lack of structure and routine, increased isolation and young people missing face-to-face contact with friends.

A top concern among respondents was how young people would transition back to "normality" once the lockdown has been lifted and how this could affect their future.

Respondents whose children are receiving help for mental health conditions are worried about how the pandemic will affect recovery.

Emma Thomas, YoungMinds chief executive, says it's important that young people continue receiving support during the pandemic.

"The pandemic has turned the lives of millions of children and young people upside down," she said.

"As our survey shows, many parents and carers are deeply worried about the long-term impact of the pandemic on the young people in their care and don't know where to turn for advice and support.

"That's why the government needs to take action, to make sure that support is available for young people and families who need it, now and as we emerge from the pandemic."

The findings of the survey, which was conducted from 9-10 May, have been published by YoungMinds as part of its 'Beyond Tomorrow' campaign. The campaign calls on ministers to take action to limit the long-term impact the pandemic has on young people's mental health.

You can find out more about the campaign by following this link.
If you need help with your mental help you can contact YoungMinds on 020 7089 5050 or by visiting the link above.

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Fears grow over long-term impact of pandemic on young people's mental health

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More than half of parents and carers are concerned about the impact the Covid-19 pandemic is having on their children's mental health, according to new research. A survey by the mental health charity YoungMinds found that 67 per cent of respondents are worried about how the pandemic will affect their children's long-term mental health.

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This article is about the issues regarding referrals for transgender children and teenagers due to the convoluted administration by the Department of Health. Despite many recent reports outlining the need for developments in trans healthcare, particularly for young people, the Irish system has regressed. This highlights the issues of both equity and efficiency.

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Trans children being referred to healthcare service that 'doesn't exist yet'

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The Transgender Equality Network of Ireland said the situation is "very concerning" and will impact up to 100 people.

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What is this news story about?
In 2015 Alzheimer's took over heart disease and cancer as the UKs biggest killer. Since corvid the deaths from this condition is on the rise. This disease needs diagnosis early for intervention, therapy and medication. The condition weakens the immune system, so having this condition puts the person into the vulnerable category. As health services are continuing to be overburden with corvid detection of this condition will be hampered.
https://www.alzheimers.org.uk/blog/research-dementia-UK-biggest-killer-on-the-rise

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This article is interesting as it highlights the lack of transgender services available in Northern Ireland. Transgender people in NI are unable to access gender affirming healthcare due to lack of funding and long waiting lists. It lags behind the rest of the UK, some patients have been waiting up to 4 years for an appointment. This article gives first hand experiences from people who have been left in this waiting system, and the effects it has had on them.

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Stock photo. Photo: FG Trade

According to the FOI data, average waiting times for those at the top of the waiting list in 2017 were 26 weeks for a first appointment, which then fell to 18 weeks in 2019, but some patients have been waiting up to four years on the waiting list for their appointment since their first referral to the clinic. In Northern Ireland, the target wait time is 13 weeks from their first GP referral to a first appointment.

There are no private GICs in Northern Ireland, and other private hospitals' do not list HRT treatment for transgender patients on their list of services. Trans people in Northern Ireland seeking treatment could travel to England, Wales or Scotland, but there are 13 clinics across the UK countries for the tentatively estimated 200,000 to 500,000 transgender people who live in the UK, all of which have long waiting lists - often even longer than the Brackenburn clinic. In any case, being treated abroad is far from ideal, as it makes it more difficult to access regular check ups that are needed.

The Institute of Conflict Research, a non-profit based in Belfast, found that of those who travelled to England, many "expressed a desire for surgical services to be provided in Northern Ireland," eliminating the need to travel after a "painful, and to an extent, immobilising" surgery.

Ted, a trans man who asked to be referred to by a pseudonym, started transitioning when he was 38 and was referred to the Brackenburn Clinic in April 2017. Two weeks after his referral, his GP received a letter from the clinic stating "we've accepted this patient but we don't know how many years it's going to be until we see them."

Ted was able to go through private healthcare. This involved attending a clinic in Brighton twice a year for the past three years, something he referred to as "taking the boat across", while his GP in Northern Ireland maintained his blood levels and administered prescriptions to him. He believes that the NHS, and particularly the Brackenburn Clinic, is being "left out to dry" by those at the top. "It's not the fault of the NHS, it's a fault of the funding they get, and the people who decide how little is given to trans healthcare," Ted said.

Nichola Mallon, a member of the legislative assembly (MLA) in North Belfast says, "The current system requires urgent overhaul. We have only one centre in Belfast providing healthcare for trans people, and the centre appears to have limited resources including staff numbers. The lengthy waiting list which has increased steadily over recent years should have been a wake-up call that the current system is not working."

Ayra Morrighan, a 25-year-old trans woman based in Northern Ireland, was referred to Brackenburn Clinic in October 2018 by her GP. She has "had no official communication with the clinic since."

"I believe on their records I'm 251 on the waiting list as of last month, but to get this information I have had to contact them myself," she told VICE World News.

Some patients on the waitlist have been offered appointments in recent weeks, but the process is slow. It is likely that most patients further down the waitlist will continue to wait for months or years for their treatment.

"Brackenburn has a notorious reputation among the trans community due to lack of transparency and communication on how they treat and engage with patients," Morrighan said.

Last year, a review of how the Brakceburn Clinic can better meet demand was commissioned, but during the review process, the service "completely broke down," according to Alexa Moore, director of Belfast-based transgender resource centre TransgenderNI, as no provisions were made for those already waiting while they looked at the clinic's issues.

Moore has seen a significant number of people seeking support from TransgenderNI because they cannot access the Brackenburn Clinic. The clinic has seen ongoing staff and funding shortages for the last two years, which the review was looking at but they have not yet reached a solution. According to the clinic's Freedom of Information Request response, "The service is currently funded for 1 WTE [whole time equivalent] consultant and 1.7 WTE therapist posts" - implying one full-time role and a part-time role. The salary of a full-time consultant ranges from £82,096 to £110,683.

Moore believes the clinic places too much emphasis on putting transgender healthcare into a mental health framework. She believes that this has led to extensive questioning and gatekeeping of those wanting to transition, forcing them to wait longer than necessary for their treatment.

She has found that many of TransgenderNI's clients have started self-medicating with testosterone and oestrogen by ordering it online instead. "The reality is that if you want to access any kind of gender affirming care in Northern Ireland, it is a choice between self-medicating or paying extortionate amounts for private care, which many folks can't afford."

Morrighan was subjected to intense questioning about her sex life, particuarly in regards to who her "previous and current partners are." She was also given antidepressants, which she viewed as an attempt to "dissuade" her from a referral to the clinic.

Morrighan has turned to self-medication while she waits for the Brackenburn clinic to see her. She turned to online websites to purchase oestrogen, which she administered herself, without medical oversight. She says, "I was forced into self-medicating as harm prevention," due to the severe gender dysphoria she felt as she waited to begin her transition.

Finley, a 25-year-old trans woman from Portadown who only wanted to give her first name, has been waiting nearly two years for her appointment with Brackenburn.

She has never been to Brackenburn, nor has she spoken to anyone from the clinic since she was first referred. "Part of the problem is that there's no transparency with them, they never email you and say, 'Hey, this is why we're closed right now, this is why we're not taking new patients,'" she says.

Not being able to access healthcare with the clinic has affected her poorly: "I have a few moments where I'm hit by gender dysphoria, thinking about how it could be. Who knows how many years it could be before I get healthcare?"

While Brackenburn has been struggling with its waiting list for years, the coronavirus epidemic this year meant access to care was pushed back even further to allow the NHS to focus on treating COVID patients. There is currently extensive pressure on the NHS in Northern Ireland, on an "over-stretched health service", due to the pandemic, making it all the more difficult for Brackenburn and their patients to access healthcare.

A letter from the Department of Health, seen by VICE World News, said that "a review into the functioning of the clinic was due in June 2020 but has been delayed due to COVID-19." The ongoing review of the clinic was also paused in March, and only resumed in September of this year. The review group found that "the Trust has faced challenges in successfully recruiting new staff" for the GIC because of the specialised nature of the services provided.

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Transgender Healthcare Is at Breaking Point In This Corner of Europe

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Stock photo. Photo: FG Trade According to the FOI data, average waiting times for those at the top of the waiting list in 2017 were 26 weeks for a first appointment, which then fell to 18 weeks in 2019, but some patients have been waiting up to four years on the waiting list for their appointment since their first referral to the clinic.

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What is the news story about?

Community health centers in US serving low-income communities that others so often neglect such as people of color and people with low income who are usually uninsured. These centers provide a holistic treatment, not only primary health services but also orthopedic care, cardiac care, dental services and mental health services.

Why is it interesting?

The community health centers are crucial in the fight against the pandemic, however, Covid - 19 has put these health centers under significant financial stress like many other nonprofits, they have lately faced financial uncertainty. Current Populations Survey in the US shows the dramatic impact of Covid -19 on Black people who have died at a rate of 1.5 times higher than white people. The article also revealed that Black workers, as compared to white workers only 5.4 per cent of vaccine recipients, a number which is significantly lower than the number of Black Americans employed in healthcare or living in long-term care facilities.

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COVID Health Equity Requires Boost in Support for Community Health Centers - Non Profit News | Nonprofit Quarterly

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Community health centers are vital players in vaccine distribution, particularly in communities of color. They need federal financial support.

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What is the story about?
It is about the difficulty of migrant's in the UK in accessing the Covid19 vaccine in fear of deportation. And the promise for a 'No deportation risk' in receiving the covid-19 vaccine by the government
Why is it interesting?
This article is interesting in terms of looking at the access of healthcare during the pandemic. It shows the importance of healthcare to be all inclusive when it comes to the people of different backgrounds, and also the legal side of it. This also opens the topic on the access for healthcare for the people that have been living in illegal immigration before the pandemic. The difficulty in access, safety and patient cent redness is quite a challenge for these group of minorities in a country.

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Steve Valdez-Symonds from Amnesty UK said many undocumented immigrants are "too afraid" to access healthcare, adding that "it has been the message, very clearly, from the government that access to health care is something that leads to information being passed about them to the immigration authorities".

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Covid: 'No deportation risk' for illegal migrants getting vaccination

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Steve Valdez-Symonds from Amnesty UK said many undocumented immigrants are "too afraid" to access healthcare, adding that "it has been the message, very clearly, from the government that access to health care is something that leads to information being passed about them to the immigration authorities".

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week4-Ola brykalska Covid-19 vaccine passports 

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week4-Ola brykalska Covid-19 vaccine passports 

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this article talks about the vaccine passports, With many individuals being vaccinated against Covid-19 every day, some political and business owners are suggesting nations can help get life back to normal by introducing a vaccine passport: which is an easily accessible and verifiable certification that a person’s been vaccinated against the disease. certain companies are already beginning to look at making shots mandatory for people who want to get on planes, cruise ships or attend events such as concerts.

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This article is about progress being made in HIV research since the Coronavirus pandemic.
The article is interesting as it highlights the danger the pandemic poses to other areas of health care and research. It reminds readers that HIV has caused huge loss of life and has been a serious issue for many decades.
Two significant ongoing trials are described, which have the potential to increase effectiveness of treatments and accessibility of prophylaxis. The article also highlights how serious a concern HIV is, especially in parts of Africa, where testing is alarmingly low. These updates have been seriously underreported so I found the article useful as a summary of what has been happening in this field while the pandemic has dominated the news.

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While global attention has fixated on the coronavirus, the forty-year long fight against HIV, which has claimed 33 million lives , is seeing new breakthroughs in preventive tools.

New discoveries of "broadly neutralizing antibodies" as well as novel regimens of pre-exposure prophylaxis (PrEP), could strengthen the world's toolbox to prevent the disease, announced the International AIDS Society (IAS) at the opening of the 4th HIV Research for Prevention Conference .

The IAS-sponsored Conference, which is taking place virtually over four days, is the only conference in the world that is exclusively focused on research in HIV prevention.

"COVID-19 has disrupted research around the world, so it's especially exciting to see this new progress," said IAS President Adeeba Kamarulzaman in a press release. "These research advances on options like broadly neutralizing antibodies and injectable PrEP could help significantly strengthen our HIV prevention toolkit."

The latest results on broadly neutralizing antibodies (bnAb) are particularly promising. In a pair of parallel trials, researchers from the Fred Hutchinson Cancer Research Center found that one of its bnAb's prevented HIV infection 75% of the time over 20 months, thus providing an important "proof of concept" to prevent sexually-transmitted HIV in the future, said the study's authors. In this case, the bnAb's were developed to recognize the 'CD4' binding site of the HIV virus.

In the two parallel trials, researchers injected participants with a placebo or two doses (10mg/kg and 30 mg/kg) of their antibody. In the American arm of the trials, enrolees included men and transgender persons who have sex with men, while the Sub-Saharan arm of the trial recruited cisgender women.

More Practical PrEP Regimens Also On Horizon

Meanwhile, two longer-acting and thus more practical PrEP regimens have been developed. They have the potential to replace common treatments that have to be taken on a daily basis, such as tenofovir/emtricitabine (TDF/FTC), also known as "Truvada".

They include cabotegravir, the first long-acting injectable regimen, as well as islatravir, a pill that would only need to be taken once a month.

As well as improving adherence to PrEP, these novel treatments could also bolster global PrEP uptake, which still falls short of the 3 million target set by UNAIDS despite a six-fold increase in uptake over the past four years, found the AIDS Vaccine Advocacy Coalition in a study that was also featured at the conference.

Cabotegravir - Injectable PrEP Regimen Works Better Than Existing Treatment

Based on a study in over 3,000 women in Sub-Saharan Africa, PreP candidate cabotegravir, was deemed safe and far superior to Truvada, complementing similar findings from another earlier trial in cisgender men as well as transgender women who have sex with men.

In this latest trial, participants received either cabotegravir plus a placebo of TDF/FTC or a placebo of cabotegravir and active TDF/FTC. Alongside daily administration of oral TDF/FTC for five weeks, participants received intramuscular injections every eight weeks.

On a positive note, women in the cabotegravir group were 89% less likely to contract HIV compared to the group that received TDF/FTC, probably because it is easier to adhere to a treatment that's taken every 8 weeks compared to a pill that must be taken every day, noted researchers.

But more funding is needed to reach global targets to eliminate HIV, warned another study that was also presented at the conference, and presented by St Luke's University.

Based on over a hundred nationally-representative datasets representing more than 1.4 million sexually active people, the study projected that the probability of reaching the 2030 targets set by UNAIDS is "very low" - ranging between 0% to 28.5% for HIV testing and 0% to 12.1% for condom use.

Unless more attention is given to the disease, the prospects of reaching these bold targets to put a stop to HIV/AIDS are rather slim, concluded the study.

Africa Should Not Be left Behind in HIV Prevention & Control

Along with reviewing new research breakthroughs, members at the Research for Prevention Conference examined the state of HIV prevention and control measures - which highlighted key concerns for the African continent.

Phuong Nguyen of St. Luke's International University presented data analysis that showed African countries are largely not on track to reach key UNAIDS targets for HIV testing and condom use by 2030.

Relying on 114 nationally-representative datasets representing more than 1.4 million sexually active people, the team estimated coverage of annual HIV testing and condom use at last higher-risk sex for each country and year to 2030, and the probability of reaching UNAIDS testing and condom use targets of 95% coverage by 2030.

They reported that the probabilities of reaching the 2030 targets were very low for both HIV testing (0% to 28.5%) and condom use (0% to 12.1%).

Within Africa, they predicted that the countries with the highest coverage of annual HIV testing in 2030 will be Eswatini with 92.6%, Lesotho with 90.5%, and Uganda with 90.5%. The countries with the highest proportion of condom use will be Eswatini with 85%, Lesotho with 75.6%, and Namibia with 75.5%.

The researchers concluded that there is little prospect of reaching global targets for HIV/AIDS elimination. They made the case for more attention to funding and expanding testing and treatment in Africa.

On the brighter side, Africa is making progress on expanding access to existing PreP formulations - and that should accelerate with the new breakthroughs just announced.

AIDS Vaccine Advocacy Coalition's (AVAC) Kate Segal noted that sub-Saharan Africa expanded PrEP access from 4,154 initiations in 2016 to 290,981 by mid-2020, comprising 44% of the global total.

She used data from AVAC's Global PrEP Tracker to identify global and regional PrEP initiation trends from the third quarter of 2016 through the second quarter of 2020.

"While PrEP initiations have grown exponentially in several countries, global uptake falls far short of UNAIDS' target of 3 million users, indicating a need for sustained demand creation where PrEP programs exist, and scale up where PrEP is provided by demonstration projects with limited reach," the study concluded.

Image Credits: Flickr, HIVR4P, Global Advocacy for HIV Prevention.

Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.

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Important Advances In HIV Prevention Unveiled: New PrEP Formulas & Broadly Neutralizing Antibodies - Health Policy Watch

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While global attention has fixated on the coronavirus, the forty-year long fight against HIV, which has claimed 33 million lives , is seeing new breakthroughs in preventive tools. New discoveries of "broadly neutralizing antibodies" as well as novel regimens of pre-exposure prophylaxis (PrEP), could strengthen the world's toolbox to prevent the disease, announced the International AIDS Society (IAS) at the opening of the 4th HIV Research for Prevention Conference .

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Week 4 – Rita Doyle What is this article about?    This article acts as a host to the discussion surrounding the expected need for increased mental health services post-pandemic. Why is this article interesting?         This article sheds light on the non-physical effects of the Covid-19 crisis.  Here the issue of overcrowding in mental health institutions is discussed; revealing how their conditions made it impossible to control the spread of the virus in one Portlaoise facility in particular, where 9 patients died.  Further, this article calls for the appointment of a new Mental Health Director, and the allocation of further funding to mental health services in anticipation of an influx of patients in need of care having experienced the trauma of the pandemic.  https://www.irishtimes.com/news/health/tds-call-for-new-hse-director-for-mental-health-amid-expected-surge-in-demand-1.4477521

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Week 4 – Rita Doyle What is this article about?    This article acts as a host to the discussion surrounding the expected need for increased mental health services post-pandemic. Why is this article interesting?         This article sheds light on the non-physical effects of the Covid-19 crisis.  Here the issue of overcrowding in mental health institutions is discussed; revealing how their conditions made it impossible to control the spread of the virus in one Portlaoise facility in particular, where 9 patients died.  Further, this article calls for the appointment of a new Mental Health Director, and the allocation of further funding to mental health services in anticipation of an influx of patients in need of care having experienced the trauma of the pandemic.  https://www.irishtimes.com/news/health/tds-call-for-new-hse-director-for-mental-health-amid-expected-surge-in-demand-1.4477521

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What is this news story about?
This article examines how Covid-19 has impacted and affected 8 key problems facing the adult social care system.

Why is this interesting?
I found this article interesting because it considers key issues facing the adult social care system pre-covid-19 and examines how these issues have been impacted by Covid-19, what inequalities have been produced and to what extent. This article also outlines the sectors lack of coherent leadership when dealing with the government and challenges with recruitment of staff. Some positives were noted such as government examining pay inequalities in the sector and the development of network mutual aid groups.

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Last year we listed the key problems as:

means testing: social care is not free at point of use like the NHS

catastrophic costs: some people end up paying large amounts and even selling their homes to pay for care

unmet need: many people go without the care and support they need

quality of care: a wide spectrum of concerns, from 15-minute care visits to neglect and lack of choice and control

workforce pay and conditions: staff are underpaid, leading to high vacancy rates and turnover

market fragility: care providers go out of business or hand back contracts

disjointed care: health and care is not integrated around the individual and causes issues such as delayed transfers of care from hospital

the 'postcode lottery': there is unwarranted variation between places in access to care and its quality.

In this long read we revisit these eight problems in the light of the Covid-19 pandemic. The emphasis on them has shifted - the first two issues have barely been mentioned during the past few months. Instead, the public focus has rightly been, first, on quality of care, as Covid-19 wrought a terrible death toll and, in many places, fundamentally changed the way care was being delivered. Second, there has also been some, though arguably not enough, focus on unmet need, as Covid-19 both created more need and made it more difficult to meet existing need. A third key area during the pandemic - though one that has had less attention - has been the difference in the ways local care systems have dealt with the pandemic and the potential consequences for the existing postcode lottery of access and provision. Two more areas that have been highlighted during the pandemic have been the sector's workforce, which has received more recognition than ever before, and to its providers, where the pandemic has exacerbated market fragility. And finally, the relationships between services - which even under normal circumstances can lead to disjointed care - have been to the fore during Covid-19, most obviously in the ongoing dispute about discharge from hospital during the early stages of the pandemic.

Quality of care

Covid-19 has had a huge, tragic impact on quality of care and also affected it in other, less obvious ways.
It is on quality of care that Covid-19 has had the most devastating consequences. Keeping people safe is a primary duty of care and the responsibility of everyone working in social care. Though providers are on the front line, the work and behaviour of regulators, commissioners, policy-makers and partner organisations, particularly in health, has a big impact on what they can do. Quality is therefore a joint responsibility.

Yet, deaths have occurred on a scale that was unthinkable before - and even in the early stages of - the pandemic. By mid-June there had been nearly 30,000 excess deaths in care homes in England and Wales. There have also been more than 3,500 excess deaths among people receiving domiciliary care, although fewer of these are attributed directly to Covid-19. As in the wider population, in care settings people from minority ethnic groups were more likely to die with Covid-19 than white people. The emotional toll on staff in care homes, some of whom lost several residents in a matter of days, is immense. The factors affecting infections and deaths in care homes are already being explored and will be critical learning for any future waves. There is also wide knowledge to be gained from other countries' experiences. More widely, there are tough questions about the preparedness and resilience of the sector for the epidemic.

But the death toll is not the only issue affecting quality of care. Reduced staff availability ( sickness absence tripled to 8 per cent in the early stages of the pandemic), lack of personal protective equipment (PPE) and other factors affected quality and availability across social care, at least in the initial stages of the pandemic (and also had a big impact on service users' access to the health services).

And quality issues go even wider than this, with potentially long-term consequences. In the urgent rush to clear acute hospitals, some people have been discharged from hospital to services that don't fully meet their needs - one in five directors of adult social services believed that in general people were not discharged to the right place during the period of rapid discharge from hospital in the initial stages of the pandemic. This may have left some people without, for example, the reablement services that might help them regain their independence. People living in care homes found their ability to leave or move around their homes restricted in the interests of infection control (although some homes went to heroic lengths to maintain activities). Family visits were suspended (or sometimes replaced by technology), as the sector and the government struggled to balance the risk of the virus with potential impact on residents' mental health (also an issue for the large numbers forced to 'shield' in their own homes). Routine Care Quality Commission (CQC) inspections were abandoned with only a very small number of intelligence- and risk-based inspections - arising from the previous history of services or new concerns raised - carried out during the pandemic.

Covid-19 increased unmet need for social care, at least in the early stages of the pandemic, but we can't yet judge the extent of that change.
Covid-19 will also have affected the level of unmet need for social care, though the picture is a complicated one, with the pandemic both increasing need but also helping to identify it: just under half of directors of adult social services said they believe there has been an increase in unmet need since March 2020.

One factor contributing to increasing need was changes to services, especially during the initial phases of the pandemic. Some people will have had services reduced as providers tried to ensure the most critical care was provided at a time when many care staff were unable to work. Other services - particularly some care homes - closed temporarily to new clients: directors of adult social services report more than 8 in 10 providers concerned about taking on new clients. Some services simply couldn't operate at all with the restrictions placed on them and closed permanently: for example, the Age UK Essex Home Help Service, which closed because it could not guarantee the safety of staff or clients. Other services, such as day centres, have been suspended as a result of social distancing rules. Many charities report having to scale back services.

The number of people affected by these changes is hard to quantify and estimates vary significantly. A Mencap survey in July 2020 found two-thirds of family members said the amount of social care support received from the local authority had fallen 'a lot' compared to the amount received before the Covid-19 pandemic, while Parkinson's UK found that nearly half of people receiving paid social care, both privately funded and council-funded, had seen a reduction in social care support. A similar MS Society survey put this at just under one in five people. Some people employing personal assistants have talked of feeling abandoned by the system, left without PPE and advice (though a chink of light has been a willingness by some councils at least to give greater freedom in the use of direct payments).

Need will also have risen because of changes in behaviour. Most local authorities report people declining care because of understandable concerns about admitting careworkers into their homes. The CQC found that admissions to care homes fell by more than a quarter among publicly funded clients and by two-thirds among self-funders. Use of home care also fell, though the CQC reports it recovering to 94 per cent of pre-Covid levels by July. It is also likely that many people did not even ask for support for the same reasons they did not go to accident and emergency - reluctance to use services and, perhaps, concern about adding to the huge existing pressure on the system. All of this will have increased the responsibilities of unpaid family carers and created many more of them - Carers UK estimates there are 4.5 million people new to caring since the start of the pandemic, 2.8 million of whom are juggling work and care.

Other aspects of Covid-19 created extra types of demand for local authorities, who reported an increase in referrals to them, generated, at least in part, by their role in local support systems for people shielding or otherwise particularly vulnerable to Covid-19. Some of this demand related to breakdowns of other services, for example, people whose personal assistants were unable to work. Directors of adult social services also reported increased demand as hospitals urgently discharged patients, while demand was also created because other people were unable to go into hospital in the first place. There were also increases in demand from people sleeping rough and because of carer breakdown.

To meet some of this increased demand local authorities have drawn on some positive outcomes of Covid-19: the new networks of neighbourhood mutual aid groups that emerged in many areas to support people and the existing deep roots of many voluntary and community sector organisations. A key question may be how to maintain and build on these networks. Councils also adapted services by enhancing their information and advice offer, re-training council staff, using more volunteers and making increased use of digital technology.

The first months of the Covid-19 pandemic have demonstrated that a consequence of social care's hugely diverse, independent provision - and of a longstanding national failure to get to grips with that structure - is a paucity of quality and timely service data and intelligence. Though there was some urgent action during the crisis to require care homes and home care agencies to provide basic data on capacity and other issues, this is just scratching at the surface of a much wider data problem in social care, especially since there is not just diversity of provision but also commissioning, with 150 different local authorities. Even basic data on the number of new requests for social care support to local authorities, local authority expenditure and the number of people who received support will not be available until autumn 2021 (when returns for the financial year beginning April 2020 are published). This is surely too long to wait to understand the 'new baseline' of social care in England.

The postcode lottery

Covid-19 may well have worsened the postcode lottery of access to social care but we don't have the data to know for sure.
Even when that data on issues such as requests for support, local authority expenditure and the number of people who received support is available, it will be a tough task to untangle it. Before the Covid-19 pandemic, there was already significant local variation in access to care and service provision. Much of this variation is unexplained and unwarranted - a postcode lottery - while some reflects differences in demographics or strategic policy decisions by local authorities (a ' postcode choice').

In a similar way, there was wide variation in the reported experience of local authorities in the early stages of Covid-19. For example, while most directors reported an increase in referrals from the community, a third saw a fall in demand of up to 10 per cent. Similarly, while most saw an increase in need as a result of hospital discharge, 1 in 5 saw a fall.

Overall, it is possible that the extraordinary circumstances of Covid-19 will have increased rather than reduced the differences between local authorities, as they decided how best to respond. Only eight took up the formal powers to 'ease' their formal Care Act duties, thereby allowing them, for example, to cease formal assessments. However most, if not all, revised procedures and services with their own individual mix of adaptation - including greater use of volunteers, information and advice - and technology, along with retraining and redeploying staff (for example, from closed day services). Working out what was done by different councils and the impact these actions had will be a difficult task.

Local authorities will also face different levels of challenge in supporting their care markets. The overall number of admissions has fallen but there is wide variation, with admissions funded by local authorities ranging from 43 per cent of 2019 levels in some places to 113 per cent in others, while self-funded admissions ranged from 25 per cent to 51 per cent of 2019 levels. The CQC observes that this could put added financial pressure on homes that are more reliant on people who fund their own care.

There is also apparent local variation in the extent to which local authorities have offered support to providers. In April, the UK Home Care Association was threatening to 'name and shame' councils that did not pass on £1.6 billion of central government funding to providers and says there is still 'huge' variation. Care England also told us there continues to be large variations in the ways by which LAs are supporting adult social care providers: 'Many LAs [local authorities] have offered support which doesn't match by any means the unprecedented costs leveraged upon providers as a result of Covid-19.'

Workforce pay and conditions

Covid-19 highlighted the inadequate workforce pay and conditions experienced by social care staff, though it has not as yet brought any improvement in them. And though the clamour for better pay for staff is now relatively strong, there is no guarantee it will last: recessions normally increase the number of people willing to work in the sector and may bring short-term relief to vacancy rates (which are now below those experienced before to the pandemic) but the question of improving pay remains key to improving recruitment and retention in the medium term. Again, there are small positive signs: the government seems now to accept the need to tackle these issues, rather than leave them entirely to the market, and there have been efforts to provide central training support to, for example, registered managers. However, these are all tentative steps, rather than the giant stride forward the sector needs.

Market fragility

Covid-19 has shaken the market, especially for residential care, and seems certain to result in the loss of some providers.
Better staff pay without more funding to pay for it would, however, create fresh problems for the sector's employers. Care providers already need to fund this year's 6.2 per cent increase in the National Minimum Wage and Covid-19 has brought new challenges to an already fragile market. However, during Covid-19 some providers have reported that local authorities have adopted less restrictive commissioning practices, and central government money being dispensed to local government to support providers has provided short-term relief in some areas. However, concern remains about the extra costs providers face for extra staffing and PPE. A Local Government Association/LaingBuisson report estimates total extra costs of more than £6 billion for extra staffing, cleaning and PPE, at a time when there is less demand (and therefore revenue). Care homes in particular are struggling with lower occupancy as a result of deaths and reduced demand. A survey of care homes by the National Care Association, which represents smaller and medium-sized homes, found average occupancy at 81 per cent compared to 92 per cent at the same time in 2019. It's not clear when and to what extent demand will return, and how many providers might fail in the meantime. One recent report suggests the homes most at risk are the 6,500 with fewer than 40 rooms, half of which have outdated facilities.

The public was concerned about care homes before the epidemic and then shocked by the scale of the tragedy that unfolded within them during Covid-19. The sector needs to take clear steps to reassure the public about safety and quality. Yet the reality is that, while we need to see wider availability and choice of services and care settings, including expansion of extra-care, residential care will remain an essential part of that mix for the foreseeable future.

Disjointed care

Covid-19 brought rapid, but enormously controversial, change in hospital discharge, with ongoing concern about its immediate and longer-term consequences.
On one level, the response to Covid-19 resolved at speed one of the issues around disjointed care that had bedevilled the sector - delayed transfers of care. The emergency procedures introduced as Covid-19 loomed freed up beds in hospitals in days. Yet the move has proved enormously controversial, with an ongoing blame game about the extent to which the practice of discharging patients into care homes without testing them for Covid-19 contributed to the infection and death rate in those homes. The Public Accounts Committee found that 25,000 people were discharged from hospital to care homes before the introduction of routine pre-discharge testing in mid-April and described this as 'reckless'. There must be questions about the extent to which this bitter controversy has caused ongoing damage in some areas to critical relationships between providers, NHS organisations and local authorities.

There was also a far less important, but nonetheless significant, financial cost to this action, with the NHS temporarily picking up the bill for people discharged into care services. This may lead to longer-term issues, especially for people whose care is publicly funded, with local authorities concerned about their long-term liability for possibly inflated fees, negotiated in a rush. Directors of social services report that in 38 per cent of councils the rates used were higher than the normal local authority or clinical commissioning group rate.

There is also concern about whether people were always discharged to the right place for their longer-term health and wellbeing. Only two-thirds of directors report ed that every person discharged from hospital in their area is getting an assessment during discharge-to-assess processes, and only 11 per cent believed everyone was discharged to the right place. This, says ADASS, could mean people 'were discharged to a care home when they could have been at home, were discharged to somewhere a long way from family, were discharged to a home that didn't have the staffing for reablement or other reasons, all of which would have negative impacts on their health and wellbeing'.

Covid-19 has had limited impact on means testing and catastrophic costs but they remain central to future social care reform.
Two problems we identified in 2019 were less affected by Covid-19, though neither is entirely unchanged.

Social care is still on a different plane (it sometimes feels like a different planet) to the NHS because access involves means testing rather than services free at the point of need. And, irrespective of Covid-19, that means test has been getting progressively meaner. People still pay for all their own care if they have £23,250 of assets, just as in 2010. A decade's worth of inflation has been ignored. And those who do have to pay for themselves may well face higher fees as providers struggle to cover the increased costs and lower income the Covid-19 pandemic has caused. They may even find themselves subsidising even more of the cost of publicly funded clients.

Means-testing creates an unlucky group of people who not only must pay for their own care but end up needing a lot of it, typically in a care home with dementia. They can easily face lifetime fees of more than £100,000 - 'catastrophic costs'. Again Covid-19 has not changed the fundamentals of this but it has made some mark. On the other hand, tragically, the appalling death toll in care homes will mean fewer people will have lived long enough to face catastrophic costs.

The extent to which social care deals with how these eight problems and how they have evolved as a result of Covid-19 will depend on a range of factors, most obviously and inevitably funding. There are real concerns not just about the extent of the increased demands on local authority resources but also the impact on the revenues used to meet them. The amount of support provided by central government to local government generally and to social care specifically will be of immense importance, particularly as the sector goes into the period preceding a three-year spending review.

However, in addition to funding, Covid-19 also highlighted linked, underpinning factors around reputation and leadership that may make it harder for the sector to tackle these problems alone.

There have never been as many media stories about social care as there have been in recent months but coverage has focused overwhelmingly on care homes, threatening to reaffirm the widespread misconceptions that social care is synonymous with care homes and with older people. There has been far less coverage, for example, of the much higher death rates of people with a learning disability during the pandemic or the severe impact of Covid-19 on the most disabled working-age adults. And it has been particularly hard to see any focus on central issues such as choice, personalisation and independence amid all the smoke and fire generated by Covid-19.

That coverage has typically also been characterised by polar opposite images: on the one hand, applause and recognition of care and support staff as 'key workers' while, on the other, lack of PPE, testing and the deaths of service users. It is by no means guaranteed that the positive image will stick with the public rather than the negative one. As we have seen, this has had immediate consequences for the viability of some of the sector's businesses, and that in turn means consequences for the people using their services. While some have little sympathy for the fate of privately run care homes, they surely have sympathy for the people who live in them and would have to move if they closed. And though recession and higher unemployment levels might push more people to consider social care as an area of work, they may do so reluctantly if they are unsure about their safety and could choose to leave as soon as other opportunities arise.

The sector's leadership has a fine line to walk in both highlighting the ongoing problems in social care and yet at the same time encouraging people to work in the sector. Similarly, leaders must somehow find a balance between expressing understandable outrage at what has happened to social care during Covid-19 and working with a government which has an 80-seat majority, nearly a full term to run and a stated intention to bring about long-awaited reform.

That balance is harder to achieve because of the fragmentation of social care. While the breadth, diversity and locally driven nature of the sector is often hailed as one of its strengths, it comes with drawbacks too. Most obviously, during Covid-19 it has meant central government was unclear about what was happening on the front line (a problem compounded by a lack of timely data). Diversity also brings with it complexity: social care can be a difficult sector to understand, and this may have contributed to (though does not excuse) the delayed central government social care response to Covid-19. This was further compounded, perhaps, by a national government tendency to centralise and circumvent local government.

More generally, the diversity of the sector creates issues around leadership. The reaction to Covid-19 demonstrated the quality, compassion and conviction of leaders in individual organisations, both locally and nationally, and there was strong focus among them on common issues such as lack of PPE and the need for testing. However, historically that unity has not been apparent when it comes to wider issues of broader social care reform. And since the sector does not speak to government with one voice, it is harder for government to get to grips with its priorities (and even harder to identify the solutions that would have wide support). Comparisons to the NHS leadership are easy but risk over-simplification - yes, the NHS has fewer national voices speaking to the government and closer alignment of asks but a centralised, command-and-control model of social care would be a huge and damaging price to pay simply for more coherent leadership.

Instead, as the sector looks to government to secure long-term reform, it needs to ask serious questions about how it best organises itself to secure commitment and action from government. Failure to learn these lessons could reduce the prospect of meaningful reform being secured and implemented well.

In summary, social care is emerging from the initial stages of Covid-19 with:

a sector, and those working in it, struggling to come to terms with thousands of deaths

services trying to get back to some semblance of normality - or even just stay in business

local authorities facing increased levels of demand but uncertain finances

(probably) wide local variations in demand, access and provision of care but no reliable data about this

a legacy of sometimes bitter disagreement about national policy and implementation.

There are some glimmers of hope in increased recruitment into the sector, wider public recognition of social care and an apparent greater willingness by national government to get to grips with some of the fundamental issues in care. And there has been an emergent spirit of community support on which to draw. Nonetheless, reform of social care has never started from such a difficult place. That, of course, is why it is so desperately needed.

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How Covid-19 has magnified some of social care's key problems

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Last year we listed the key problems as: means testing: social care is not free at point of use like the NHS catastrophic costs: some people end up paying large amounts and even selling their homes to pay for care unmet need: many people go without the care and support

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This article is interesting as it shows the lack of efficiency in the national cervical screening programme and how it has detrimental effects on patients. It is horrific how four smear tests over six years came back negative and it was only later on when she went to her GP with bleeding, she was diagnosed with cervical cancer.

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A 32-year-old woman who is seriously ill with cancer has settled her case against the HSE over the reading of her cervical smear tests.

Speaking outside court afterwards, Lynsey Bennett said she could now "focus on my own fight to stay alive as long as I can".

Her case was due to start at the High Court today but was settled through mediation.

Ms Bennett, who has two young daughters, had four smear tests between 2010 and 2016, but each time was told they were negative.

After her last smear test in 2016, she was told no abnormalities were found and she would be called for routine testing in three years' time.

Eleven months later, she went to her GP with bleeding, and in January 2017 she was diagnosed with advanced cervical cancer, requiring a hysterectomy.

In 2018, her cancer returned and she is now seriously ill.

Lynsey Bennett focusing on 'fight to stay alive' after settling her case against the HSE over the reading of her cervical smear tests | Read more: https://t.co/PXrd3zPdCr pic.twitter.com/VaqnsOe1Sy
- RTÉ News (@rtenews) February 3, 2021

Last December as she prepared for her High Court case, she recorded a video on her Facebook page in which she delivered an emotional message to the Government. The video was viewed online by thousands of people.

In court today, a statement was read on behalf of the cervical screening service expressing "deep regret" to Ms Bennett and her family and acknowledging the "many challenges" she had faced.

The service said it was appreciated that this had been a very difficult time and it was hoped the settlement would provide some solace.

The terms of the settlement were not disclosed in court and the settlement was made without admission of liability.

Ms Bennett told Mr Justice Kevin Cross she intends to set up a trust fund for her two daughters.

Ms Bennett, from Ennybegs, Killoe, Co Longford had sued the HSE, and two laboratories over her cervical smear slides taken under the national screening programme.

In her action for damages it was claimed there was a failure to correctly report or diagnose, and an alleged misinterpretation of, Ms Bennett's smear samples.

Her lawyers said her cancer was allowed to develop and spread unidentified, unmonitored and untreated until she was diagnosed with cervical cancer in January 2017. The claims were denied and the case was due to start at the High Court today.

Ms Bennett had a smear test on 3 February 2010, which was sent to Eurofins Biomnis in Dublin. The test came back as negative and another smear test was recommended in three years.

On 16 December 2013, Ms Bennett had another smear test as part of the national cervical screening programme.

This sample was sent to US lab Quest Diagnostics and came back as showing atypical squamous cells of undetermined significance. A smear test in 12 months was recommended.

On 2 December 2014, Ms Bennett had another smear test and the sample was reviewed by Quest Diagnostics.

It was claimed the result came back negative and she was advised by CervicalCheck there were no abnormalities and a repeat smear in a year was recommended.

She had another smear test in January 2016, which was tested at the US laboratory Quest Diagnostics, and she was told no abnormalities had been detected and she would be reminded to have her routine smear test in three years' time.

Eleven months later, she went to her GP complaining of bleeding and was referred to hospital.

In January 2017, invasive cervical cancer was diagnosed. Ms Bennett had to have a hysterectomy and other surgery.

In March 2018, she was found to have a recurrence of the cervical cancer. The court heard today there was a "limited life expectancy" in the case, but she is pursuing new treatment options both in Ireland and abroad.

Speaking outside court afterwards, Ms Bennett said: "I stand here today extremely grateful to everyone who has supported me and the girls since my first diagnosis in 2017 - my family, friends, strangers, and of course my legal team.

"I send my love to all the women and their families who have fought and continue to fight our heartbreaking illness.

"I can now focus on my own fight to stay alive as long as I can.

"To my daughters, Zoe and Haley, I hope I have done enough to secure you both a future free from financial worries and that even with me not here to guide you that you can both pursue your dreams and remember Mammy loves you."

In a letter read to the High Court, CervicalCheck CEO Fiona Murphy said she wished on behalf of the CervicalCheck programme "to express our deep regret to you and your family".

She added: "I wish to acknowledge the many challenges that you have faced as a result of your diagnosis. I appreciate that this has been a very difficult time for you and your family and I hope you find some solace with the conclusion of this process."

Ms Murphy said she hoped the settlement will give Ms Bennett and her family "some level of comfort, peace of mind and security".

The letter concluded: "With deepest regret."

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Woman focuses on 'fight to stay alive' after settlement

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A 32-year-old woman who is seriously ill with cancer has settled her case against the HSE over the reading of her cervical smear tests. Speaking outside court afterwards, Lynsey Bennett said she could now "focus on my own fight to stay alive as long as I can".