College Health
Service
Annual Report 2012
1
The mission statement of the College Health Centre
adopted by Board (June, 1999)
“The mission of the College Health Service is to provide ambulatory health
care for the College Community, to promote health education within the
College and in so doing, encourage healthier life styles and a safe working
environment for both staff and the student body.”
2
This report covers the calendar year 2012 аnd is an
assessment of the current situation at the College Health
Service. It highlights current activities and trends at the
College Health Service and also reflects areas for concern at
present and in the short term.
3
The team comprises General Practitioners, Nurses, a Psychiatrist, a
Physiotherapist and an Administrative unit.
Student consultations are free of charge with modest charges for
additional services.
Staff consultations attract a fee per visit to the service.
The service is funded through a combination of Cista Communis
contribution and locally generated income.
Medical / Clinical Services
Activity
We continue our policy of providing an ambulatory health care service
available to all undergraduate and postgraduate students on campus,
Monday to Friday, 9.00am to 5.00pm. The basic consultation is free of
charge, but modest charges are imposed for vaccinations, laboratory
tests, physiotherapy and medical examinations for insurance
companies and external employers. In term time we endeavour to
have at least three GPs consulting each morning and at least two each
afternoon. Even with this level of service, such has been the demand,
that the average waiting time for routine appointments through the
past year was in excess of one week.
In addition to booked appointments we also provide a "sit and wait"
emergency service each morning and afternoon. Prior to this year only
a small number of patients could be seen in each of these sessions.
This year however we have allocated a GP for ninety minutes each
morning and the entirety of each afternoon to manage walk-in patients
and this has been reflected in a significant increase in the number of
walk-in patients seen each day.
By taking this GP away from routine appointments each afternoon,
however, the waiting time for routine appointments has increased but
at least we are in a position to provide a same day service for urgent
cases.
Closely allied to these clinics are the booked nursing clinics which run
all day, and the very effective triage system, whereby a nurse can
make an assessment of the severity of the student`s illness and
prioritise their care in the "sit and wait" surgery
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In addition to our core service to the Student Body we provide
Seven consultant psychiatric sessions per week for
students with moderate to severe mental health problems.
These students are referred from the College Health Service GPs,
Counselling Service, Disability Service or occasionally from
external Psychiatrists. Registered students are assessed and
treated by the College Psychiatrist free of charge.
Twenty four hour cover through Mediserve Homecare Ltd
and DUBDOC, an out of hours service based in St. James
Hospital. This involves my participation in the DUBDOC roster at
weekends, bank holidays, and evening sessions in St. James’
Hospital on average two sessions per month. Physiotherapy
clinics, two sessions daily, Monday to Friday for staff and
students from September to June, at a cost of €20 for students
and €40 for staff.
Twice weekly Sexual Health Clinics in association with St.
James’ Hospital, Genito-Urinary and Infectious Diseases
Department, attendance fee €15.00 in lieu of specimen transport
costs and €20.00 deposit to discourage non attendance.
Nurse led contraceptive advice, smears and Chlamydia
screening.
Staff GP sessions daily, attendance fee €45
Travel Health and Vaccination for Staff and Students, at
highly competitive rates. There has been a dramatic fall in the
demand for Travel Vaccination due to the downturn in the
economy.
We work closely with the Medical and Dental schools to
provide travel medicine advice to those students travelling
abroad for their electives and we run specific Travel Health and
vaccination clinics for these groups.
Hepatitis B vaccination clinics for Health Science students,
and for Clinical, Academic and Service Staff in at risk
occupations.
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Staffing plan
Staffing levels and funding sources
3.4 Full time equivalent GPs
2 Full time equivalent nurses
2.4 Full time equivalent administrative officers
7 Consultant Psychiatric sessions October to June
summer period.
reduced over
9 Sessions Physiotherapist October to June
Resourcing of Staff
Combination of Cista Communis and Non Pay
Budget
Cista
Non Pay
Director GP DMG (1fte)
Assistant Director NF (0.7fte)
2 GP`s NM /MS (1fte)
2 Nurses CC / AF (1fte)
2 Senior EO`s AW /EH (1.8fte)
2 GPs CH /AW (1.4)
1 Nurse CL (1)
Physiotherapist (0.7)
Health Promotion (0.2)
Receptionist (0.6 )
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Budgeting
Previously Budget allocated annually
Non Pay Budget balance annually
Difficulties from 2009
Increased student numbers
Increased diversity
Increased Fixed costs,
93% of non-pay budget is staff costs.
40% increase in Medical indemnity fees in 4 years
10% increase in Drugs / Dressings pa
allied to
Central reduction in GMS fees
Reduction Discretionary spend, Travel, Regular check-ups
Use of College Health Service by
Demographics
Irish Male 18yo UG
1.0
Irish Female 18yo UG
1.7
All Post Grad
2.5
International Post Grad
4.5
In previous Annual Reports, I have outlined in detail the implications of
the lack of space for service development within the College Health
Service. It was clear that it was not physically possible to put more
patients through the system due to the structure of the premises and
its inability to cope with the current student body of over 16,000. This
year, there has been a reduction in the usual throughput in the
Nursing Department. This was as a direct affect of the Croke Park
agreement where one of our nurses was not replaced during a period
of sick leave.
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This year there was an increase in the number of pre-employment
medicals carried out on behalf of the College but this was significantly
lower than the norm as a direct result of the recruitment embargo in
the public sector, which came into effect on 1st April 2009.
The number of face to face consultations with the College Psychiatrist
increased in 2011 by 26% on the previous year. This year the
increased figure has been maintained.
A new initiative, focusing on the needs of those students with
Aspergers and ADHD which was piloted in 2010, has been maintained
by the College Psychiatrist who supervises two Senior Registrars in
Psychiatry who are carrying out research in this area.
Substantial need had been identified in this area and we are grateful to
the College for providing the extra resource to cater for this demand.
Demand for the Sexual Health Clinic is continuing and having
experienced a 20% increase from 2010 to 2011 the demand remained
much the same this year. In addition the waiting time for the Sexual
Health Clinic increased and that is an area that we will hope to address
in the next session.
One area where a significant reduction in demand was seen was the
area of travel vaccinations and immunisations. This is a clear
barometer for the economic status within the country as a whole. It
also reflects the huge increase in travel vaccines and travel clinic
appointments provided in the preceding five years which meant that
the majority of non first year students had already been vaccinated
and most of these vaccines have a three to ten year cycle. This drop
in demand for travel vaccines will inform our decision on clinic
allocations for 2013 and it is highly likely that this will enable us to
reduce the travel clinic provision and increase the level of general
appointments.
Total attendance has remained static although demand has increased.
Effectively, with premises which were developed for a college
population of no more than 10,000 students and staff combined, the
service is bursting at the seams. Various factors contribute: patient
satisfaction with service, increased expectations, crises in accident and
emergency and the cost of surrounding GP services for the
overwhelming number of students that do not qualify for medical
cards.
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The increased demand for a finite resource has led to significant
waiting times for routine appointments. The average waiting time to
see a GP in 2012 was 7.5 days, an increase from 4 days the previous
year and was as high as 20 days at peak times of the Academic year
There were 12,425 face-to-face Consultations with students. Of these,
almost 30% were emergency or “sit and wait” consultations.
The increase in this area reflected the allocation of a GP specifically for
the ‘sit and wait’ category each afternoon. This has allowed us to
respond rapidly to the need for same day consultations.
The number of consultations per GP per three hour session averaged
17 in term time, reducing to 15 in the summer. This should be seen in
line with the recommendation of 15 minutes per consultation of the
Royal College of General Practitioners i.e. 12 consultations per 3 hour
session.
Trends in Workload
GP Student
2011
12,283
GP Telephone 3,925
Nurse
8438
consultations
Psychiatric
1,044
consultations
Physiotherapy 1,442
Pre Emp
239
Medicals*
Sexual Health
581
clinic
Staff clinics*
1214
Hepatitis B
1815
TOTAL
30,981
2012
12,425
4,174
8,062
1,018
1,471
414
576
1,239
1,300
30,679
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Additional Duties of the Director
In addition to routine clinical duties, the Director is also involved in
several Administrative and Teaching roles throughout the College.
Examples are: Member of the Heads Forum
Member of the Senior Administrative Management Team
Member short term Fitness to Practice Working Group
Liaison with Senior Lecturer’s Area to assess Absences and Readmissions to College on Medical Grounds via the Dean's consultation
Group
Assessments of Fitness to Practice Issues for Students on Professional
Courses
Allocation of Student Accommodation on medical grounds
Providing medical opinions to The Junior Dean, The Warden of Trinity
Hall and the Tutorial Service
Chair of the College Health Week Committee
Member of the Radiation Safety Committee of the Dental Hospital
Member of the College Administrative Services Safety Committee
Member of the College Safety Committee
Lectures to Junior Freshman Medical Year as part of the Psychiatry
Course.
Coordinates the Medical and Dental Electives and Russian
Department Travel Medicine requirements
Assesses all new Pre-Employment Medicals for College in association
with the Staff Office.
External to the College, the Director is involved as Joint Course
Director in Minor Surgery for GPs with the Irish College of General
Practitioners (ICGP)
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Review of Planned Clinical Developments
for 2012
In my last Annual Report I identified two clinical issues which we would
aim to develop in 2012. Each were in the area of psychiatry. We were
successful in launching a service for students with Eating Disorders
with clinical input from the College psychiatrist, two GPs, a student
health nurse and a counsellor from the Student Counselling Service.
This service has now facilitated several groups of students through
the six week programme. The service has involved very close cooperation between the College Health and Student Counselling
Services and to date the feed back has been very positive particularly
for those students suffering from Bulimia Nervosa.
Some minor changes to the programme which involves different
modules focusing on all aspects of the physical and psychological
issues related to eating disorders have been made. Our close working
relationship with the Student Counselling Service is a significant
advantage to this group of students who can also avail of the expert
Internal and External Groups running on campus related to Eating
Disorders.
In addition, the Service was involved as the control arm of a large
research project led by the Department of Psychiatry at Beaumont
Hospital, looking at disordered eating patterns in young people. A
much higher level of eating disorders of all types was identified and we
are grateful to those students who participated in the study and who
gave us permission to contact them. This group will be the focus of
our Eating Disorder Strategy for 2013.
The findings were presented at the Annual Scientific Meeting of the
Irish College of Psychiatry and at the Irish Student Health Conference
in UCD in March and have now been submitted for publication.
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The second projected clinical development was a spin off of the
Alcohol management programme initiated in 2011 and funded with
the assistance of the Office of the Junior Dean and has been coordinated by Mr. Rolande Anderson from the ICGP in conjunction with
Dr. Farrelly and Dr. McGrath. Several workshops have taken place in
which those students who have been identified with alcohol problems
have been invited to attend and again the feedback from this resource
has been excellent. In addition, we have taken on the practice of out
patient detoxification and management of patients with severe alcohol
problems. Clare Lynch, Nurse and Dr Farrelly have supervised a
number of such cases this year and we hope to meet the demand for
this Service in 2013.
In addition the director, in association with the IUSSN and his
counterpart in UCC, met with Minister Shorthall at her request, to
represent the views of the College Health providers around the country
in relation to the drive to reduce the consumption of alcohol and
thereby reduce the Health and Social implications of alcohol misuse.
This is an ongoing project and will be a focus for next year.
Dr Farrelly, in association with the Child and Adolescent Psychiatry
Unit at Tallaght Hospital, is supervising a Specialist Registrar to run an
in house Assessment for Adult Attention and Hyperactivity Disorder.
This service augments the work of the Disability Service through
Unilink and is a major additional cost neutral resource for 2013
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Review of Planned Non-Clinical
Developments 2012
Non-Clinical developments focused in the main on planning for the
proposed move of the College Health Service to the new Student
Centre, which was to be based at Luce Hall. Unfortunately, the
referendum on this issue was not approved by the student body. The
need for additional space is more pressing with each increase in
student numbers and the procurement of adequate premises remains
a priority for the service
The existing Computer System, Dynamic, had been in place for several
years and was upgraded by Helix Health in late 2011. A major
difficulty with the system made it impossible to generate accurate
reports for almost a year. Our colleagues in IS Services have
approved the systems reporting system. We are most grateful to ISS
for providing us with the technical expertise in liaising with Helix
Health and despite significant teething problems we expect that the
system will prove very helpful in both the management of the Clinical
and non Clinical systems within the College Health Service.
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Current Areas of Concern
Premises
The single overwhelming issue currently affecting the Health Service is
one of Clinical space. We have developed an excellent
multidisciplinary team that unfortunately is severely constrained by a
building that is no longer fit for purpose.
A great advance at the time of its development, the current building
was designed for a situation where the student and staff numbers
would never exceed a combined 10,000.
The figure for the academic year under review is 16,747 students and
2,839 staff, a total of 19,586 and this is likely to be increased by a
further 5% in 2013
Any further growth in student numbers will compromise our ability to
provide safe, quality health care provision for students. We may also
have difficulty in fulfilling our obligations to the Health Authority under
the General Medical Services scheme.
Trinity has always led the way for other Irish Universities in terms of
Health Provision for students, but we are now significantly lagging
behind our counterparts, in particular UCD, UCC and NUIG on the issue
of premises. The Trinity Experience promises a holistic supportive
College environment and a modern College Health Service is a crucial
element in facilitating the journey of the student on his or her
academic path.
In addition, the demographics of the student body is changing and
with the current drive for increased numbers of International and
Post–Graduate Students, there will be increased demands on the
service, as each of these groups require significantly more medical and
psychiatric support.
Additional space would not alone allow for greater service provision for
students, it would also create the possibility of greater income
generation by the service, which may offset much of the running costs
of new premises.
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In the context of the proposed development of a new Student Centre
at Luce Hall, I supplied the Director of Buildings’ Office with a template
and floor plan for a new Health Centre. As the current Health Centre
was built at little cost to College following a wonderful gesture from
the Buckley foundation, it is to be hoped that College would see fit to
provide the service with a modern purpose built premises, should it be
deemed necessary to demolish the current Buckley Foundation funded
premises. The fact that the original plan for Luce Hall, including bars
and a gig venue, was not approved may inform the Planning
Committee of the need for a Student Experience / Welfare focus to the
building with allocation of space to cognate services.
Staffing Levels
There has been a severe impact on the Service both in overall staffing
levels and in particular related to difficulty in gaining approval for short
term replacement of staff on sick leave or maternity leave due to the
constraints of the Croke Park Agreement. The Agreement is a blunt
instrument and discriminates significantly against smaller units and
those with a preponderance of female employees. The College Health
Service staffs comprises 12 females and one male and clearly a unit
with such a demographic will be disproportionately affected in terms of
lack of cover for maternity leave when compared with more gender
balanced areas.
I am delighted to report that approval was given for maternity cover
for one of our GPs who was on maternity leave for part of 2012 and
this enabled us to maintain the consultation levels this year.
Clinical Priorities for 2013.
To maintain the current level of Service within the boundaries of the
Croke Park Agreement (Public Service Agreement 2010-2014)
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Health Promotion
Getting non exercisers exercising
Smarter Travel initiative on-going. Emphasis on encouraging walking,
cycling and using public transport to get to College. Activities include
setting up a bicycle users group (BUG group) for new cyclists who
would like an escort to teach them good road safety on their bike,
promotional activities, improving bike parking facilities and improving
information on what public transport is available and how to use
facilities like Dublin Bikes.
Trinity Operation Transformation in January and February to
encourage people to eat healthily and get active. Activities include
encouraging people to form exercise groups, offering anyone in a
group free sports centre instructors, reduced price sports centre
classes, a weekly walking/running group, free sessions with affiliated
Trinity sports clubs, free information sessions with DU/DIT Nutrition
Society undergraduate dietitians, online cooking demos in
collaboration with DU/DIT Nutrition Society, the Catering department
and Trinity TV, applying for funding for the Department of Health’s
national Count Me In campaign from TCD Association and Trust.
Ann Fitzgerald fund to encourage student led promotion of physical
activity. Two grants made available to individuals or clubs with
innovative ideas for encouraging their peers to increase their physical
activity.
Stopping Smoking
Increase awareness of the Health implications of smoking аnd continue
to offer Smoking Cessation clinics to those students аnd staff who are
motivated to stop smoking. Offer brief intervention training to
encourage students and staff to promote smoking cessation services
within the college.
Mental Health
Promote student led stress management by training S-2-S student
mentors to run relaxation classes. Include staff in the delivery of the
training to promote sustainability.
Alcohol Misuse
Bring a focus to bear on the issues related to the misuse of alcohol
amongst the College population аnd facilitate the modernisation of the
College Alcohol Policy to reflect the current social and health concerns
of the general public. Apply for funding to the Trinity Association and
Trust to undertake a study of effective interventions in the College
setting in preventing alcohol misuse.
Health Week
Work as part of committee to run College Health week.
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