ST. PATRICK’S HOSPITAL (CORK) LTD.

ANNUAL REPORT 2013

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Contents

Report of the Chairman 3/4

Report of the Chief Executive Officer 5

Report from the Consultants in Palliative Medicine 6/7

Nursing

Report from the Director of Nursing 7-8

Specialist Palliative Inpatient Unit 9-10

Service for Older People 11-12

St. Luke’s Day Care Unit 13

Community Palliative Care Service 14-16

Paramedical and Pastoral Services.

Bereavement & Family Support Services 16-17

Chaplaincy 18

Physiotherapy 19-20

Administrative and Service Support

Administration 21-22

Catering & Housekeeping 22

Portering 23

Volunteers 24

Education 25-28

Summary Financial Statements 28-31

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Report of the Chairman. Following extensive consultation with the general public, the Religious Sisters of Charity, patients/residents, hospital staff and the Friends, it was decided to adopt the new title Marymount University Hospital & Hospice (Marymount, in short). To comply with formal registration issues, this new name (related logo, headed notepaper, email and website addresses etc), did not take legal effect until 8th January 2014. During the rebranding process, to retain a definite link with our Wellington past, there was overwhelming support to retain religious names for the hospital’s wards. In addition, the chapel in Marymount has been renamed St. Patrick’s Oratory. Special thanks to Irene Hegarty, Hugh Morley and Sarah McCloskey who led and coordinated the rebranding consultation. The Board of Marymount believes that the Religious Sisters of Charity’s historical links with Cork, extending over 140 years, since St. Patrick’s Hospital first opened in 1870, should be formally recognised in our new facility in Curraheen. Accordingly, the hospital’s Education Centre was dedicated to the memory of Mother Mary Aikenhead, foundress of the RSC in 1815, at a special ceremony held on 18th January 2013, almost coincidentally the day before her birthday, in Daunt’s Square, on 19th January 1787. Past and current Board members, hospital staff and especially members of the Religious Sisters of Charity were in attendance. Many of the latter themselves gave dedicated service to St. Patrick’s Marymount over the years. The hospital’s website (www.marymount.ie) was updated during 2013. There is now a revised welcome page, with quick links to hospice & palliative care, service for older people and volunteering. The hospital now has control over the website’s content which is regularly updated by hospital librarian, Aoife O’Connor. Various other IT initiatives, under supervision of Finance Manager, Tony O’Brien, including in-house staff training, a review of application software and website & HSE Integration remain ‘work in progress’. Implementation of the recommendations of the Internal Structures Review (O’Mahoney Report, May 2012) was further advanced throughout the year. The input of Prof. Geraldine McCarthy and Mr. Liam Murphy, as external facilitators, to the implementation process is acknowledged. The new structure has ensured a more streamlined and efficient working matrix of three main pillars/divisions, each with a designated lead person who, together with the Chief Executive, Head of Human Resources and the Head of Finance Officer, form the hospital’s Executive Committee. The hospital’s first Strategic Plan, was formally adopted by the Board of Directors at the year-end following much consultation that included ‘away’ days for the Board & Executive. It can be accessed on the hospital’s website. Its roll out and the suggested timelines for the many recommendations will be closely monitored. In March 2103 the Health Service Executive (HSE) told hospital management that an additional €2.1m funding would be provided to open the much needed second specialist palliative care ward that would provide an additional 20 beds. On the downside we were also told that the approved additional thirty-six staff would not be covered by the Voluntary Hospital Superannuation Scheme (VHSS), the pension scheme available to existing staff. This and several other challenges in commissioning the new ward not least the recruiting of the additional staff meant that the second ward did not open during 2013. The year ended with the hope that St. Christopher’s would be ‘up and running’ early in 2014. The Board is appreciative of the tireless efforts of fellow directors Paul Moran and Joe Hayden and our Chief Executive Officer, Kevin O’Dwyer for their collective input in reaching an amicable settlement with BAM Contractors on the final contract sum for our new facility in Curraheen. The contribution of Mr. Tim Ahern, Conciliator in facilitating these discussions is also acknowledged. Much thanks too to HSE for vital financial assistance. There remain some ongoing defects that are being slowly addressed.

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The terms of the 4-year lease, to 2016, of the Wellington Road Site with Griffith College with an option to buy at the end of the lease was agreed and signed off during the year. The building contractors were now on site to make the building ready for use by Griffith College and St. Angela’s School – who have sub-let from Griffith whilst their parent school is being upgraded and renovated. Income from the HSE and the Nursing Home Support Scheme (NHSS) provides 71% of the hospital’s total operating costs. We remain reliant on the fundraising efforts of The Friends of Marymount and on individual donations to the hospital for the remaining 29%. Another hidden contribution to the services provided to patients and residents was that provided by up to 200 volunteers who selflessly assist the staff and patients in a variety of ways throughout the year, without remuneration, to make life as comfortable and as satisfactory as possible for patients and residents. Challenges faced include the hospital’s ability of to pay its creditors if the €300k for 2013 pension liabilities was not paid by the HSE. The draft budget for 2014 had been considered at the Finance Committee meeting. Cuts from the Haddington Road Agreement of (€130k), and a moratorium cut of (€206k) were envisaged. There was general consensus that the hospital did not have the capacity to cope with these cuts on top of a €200k shortfall from 2013, without a fundamental and radical assessment of its services. In difficult economic times, after successive funding cuts and facing structural changes in the health service nationally, and needing to raise at least €2m per annum in fundraising for running costs and capital repayments, remains the ongoing challenge. The phenomenal fundraising efforts of the Friends of St. Patrick’s-Marymount (renamed Friends of Marymount, as of January ‘14) remain a truly remarkable reality. Quite simply without the voluntary, selfless and tireless dedication of the Friends, throughout Cork city and county and beyond, the quality care provided to our patients and residents in the hospital and community could not be realised. Ms. Kay O’Sullivan’s six-year term as a Director of St. Patrick’s Hospital (Cork) Ltd. concluded on the 15th May 2013. Her immense contribution to the hospital was formally recorded at the May 2013 Board meeting. At that same meeting Prof. Geraldine McCarthy was approved as a new board director. St. Patrick’s Hospital (Cork) Ltd. had won the 2013 Hotel & Catering Review Gold Medal Award for Best Institutional Catering establishment in Ireland. Heartiest congratulations are due to Ms. Marie Foster and her staff in the Catering and Housekeeping Department on this outstanding achievement There was an unannounced inspection of the hospital by the Health Information & Quality Authority (HIQA) on the 10th September 2013. 10 outcomes had been reviewed and the Hospital was substantially compliant. Recommendations were made on three outcomes namely i) improvements in person-centred care plans, ii) the dining experience and iii) the completion of staff files. In the early autumn our Chief Executive Kevin O’Dwyer indicated that he planned to retire in May 2014 after 17 years at the helm. The procedure to recruit his successor was launched in December 2013. Whilst Kevin’s retirement is more correctly a matter for inclusion in the Chairman’s report for 2014, I might be permitted, in my final months as Board Chairman, to formally thank Kevin for his sterling leadership and commitment to Marymount. We are greatly indebted to him and wish him and his wife Joan a long and happy next phase to their lives. I would like, on behalf of the Board of Directors, to pay tribute to the hardworking executive and staff of Marymount for the quality, professionalism, respect and kindness with which care is delivered throughout the hospital and in the community. It is greatly appreciated. In conclusion, I thank the Board of Directors for their unstinting support to me and the dedication with which they have fulfilled their responsibilities. Cillian Twomey Chairman, Board of Directors

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Report of the Chief Executive Officer. 2013 was the sixth successive year of cuts in the hospital’s budget, and was the most challenging for two seasons. Firstly, we suffered the most severe cut to the hospital’s budget to date, with €350,000 being withdrawn from the core budget, made up of a 1.6% reduction in the palliative care allocation, a 2.6% reduction in the service for older people allocation, and a €206k reduction as a “moratorium” cut. Secondly, there was little scope for further efficiencies after the previous years’ cuts. With very tight control over pay costs, (helped by the implementation of the Haddington Road Agreement half way through the year), and an increase in income for insured beds, we managed to cope with the percentage cuts. The moratorium cut proved to be a cut too far, though, and despite our best efforts, the cash deficit at the end of the year was €200k. Despite the financial pressures, the hospital made significant advances on a number of fronts. Agreement was finally reached with the HSE South on the funding for the second palliative care ward, and plans for equipping and staffing the ward immediately commenced. One of the first posts to be filled was the third consultant in palliative medicine post, albeit it on a part-time locum basis, but the additional consultant input was most welcome. Pension access issues delayed the start of the recruitment process, but the 20 new beds were expected to be opened in the first half of 2014. New management structures were successfully introduced during the year, on foot of the 2012 management review. This involved the combining of hospital departments in groups, with the aim of reducing the number of people reporting directly to the C.E.O. and improving communication and decision-making. We also produced a strategic plan for the hospital, another recommendation of the review, which will guide the development of the hospital for the next three to five years. One of the most significant projects during the year was the preparation and planning for the change of the hospital name from St. Patrick’s Hospital (Cork) Ltd. to Marymount University Hospital & Hospice in 2014. In a related development, the Education Centre was dedicated to Mother Mary Aikenhead, and the oratory was named for St. Patrick. Separately, the hospital website was upgraded and modernised, and a number of volunteer-driven initiatives in the ITC area were introduced. Some of the long-standing defects in the building were finally rectified, most notably the problems with the fire doors, heating and balconies, but a number of leaks persisted, as did the problem with the food macerator system. The settling of the final account with the main contractor, after the hospital negotiated a second capital grant with the HSE, was the catalyst for the progress, with the contractor committed to resolving all outstanding issues. Pressures on the service for older people led to a reluctant decision to re-designate 6 respite beds as continuing care beds at the end of the year. The service was the subject of an unannounced inspection by the Health Information and Quality Authority in September, and the positive reports achieved in previous inspections were maintained. The hospital’s reliance on fundraising and on its wonderful volunteer force grows each year, and we are ever-grateful for their support and the support of the people of Cork. Marymount could not function without it, but it can look forward to the new year with confidence because of it. Thank you.

Kevin O’Dwyer Chief Executive Officer

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Report from the Consultants in Palliative Medicine The specialist palliative care services located at Marymount Hospice are designed to provide a co-ordinated and integrated service for patients and families with complex specialist needs. The clinical programme is based at Marymount in Curraheen and the programme is delivered across multiple sites. The philosophy underpinning our practice is that we provide a fully integrated service available to all appropriate patients wherever and whenever it is required. Marymount is the hub of the service and the medical team is based there. In addition to the medical services provided in Marymount (in patient care, community based care, day care and outpatient services) the medical team attend the city hospitals and together with the Palliative Care Nurse Specialists (CNSs) provide a palliative care service to patients in the acute setting. Those patients accessing our service need to be able to transfer seamlessly across care settings as their clinical needs dictate. This can only be achieved by strong working partnerships with other health care professionals. We work closely with colleagues in the health service across all care settings and greatly appreciate the support and working relationships established over many years. In times of ever diminishing resources we have to depend on close collaboration to ensure that patients remain at the centre of all our endeavours. Time and again we experience hospital Consultants and their multidisciplinary teams across all specialities going an extra mile to address a clinical issue for one of our patients. In the community we experience tremendous co operation and support from our General Practitioner colleagues including the out of hours South Doc service. We are also indebted to our other community based colleagues such as Public Health Nursing services, Allied Health Professionals and Community Pharmacists whose work is crucial in maintaining ill patients at home. All our non consultant medical posts in Marymount are recognised training posts affiliated to the Royal College of Physicians of Ireland (R.C.P.I.) and the Irish College of General Practitioners (I.C.G.P.) The R.C.P.I. have specific criteria which define the requirements of each training site and programme. We under went an inspection visit from the R.C.P.I. this year and were approved as a training site for a further five years. We have formal links with University College Cork and have medical students in attendance throughout the year. The medical team is actively engaged in audit and research activity and their work has been presented at national and international meetings. Education is a key component of our work and members of the team contributed to educational programmes locally, nationally, and internationally. Some of this work was submitted for publication. Team members sit on a number of internal and external committees and have participated in developing local, national and international policy. In 2013 we said goodbye to our Specialist Registrar (SpR) Dr. Deirdre Finnerty and we were pleased that Dr Fiona Kiely was remaining with us for another year of the training programme. Our Registrars Dr. Claire McAleer and Dr. Alison Cran also left us to take up places on the Higher Specialist Training Programme in Palliative Medicine, Dr. McAleer on the Irish programme and Dr. Cran returning to the U.K. to take up a training post there. We have two Senior House Officer posts shared between general medical and general practice trainees, and eight doctors rotated through these posts in 2013. The Non Consultant Hospital Doctor (NCHD) medical team changes in July of each year so an entirely new team of NCHDs started with us that month. An additional Registrar post was recruited in anticipation of the opening of 20 additional specialist palliative care beds.

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We welcomed SpR Dr. Elaine Burke, Registrars Dr. Helena Myles, Dr. Rachel Collins and Dr. Meenashki Uppal and two SHOs. It is always a challenging transition for a new NCHD team and as their supervising Consultants we are very grateful for the welcome and support provided to them by our nursing and allied health colleagues. It is noteworthy that those going on to specialise in Palliative Medicine via the R.C.P.I. Higher Specialist Training Programme are frequently doctors who have worked in Marymount early in their careers as SHOs. Those training as GPs feedback on the importance of a Palliative Medicine post as part of their clinical experience to enhance their skills in that area of practice. The environment in our new facility has greatly enhanced the therapeutic experience for patients and their families. We look forward to opening the additional twenty specialist palliative care beds in 2014 and are very grateful to all who are working hard to ensure this happens. Dr. Marie Murphy Dr. Tony O’Brien Consultant Physician in Palliative Medicine Consultant Physician in Palliative Medicine

Nursing. 2013 brought about more challenges in terms of the hospital meeting financial targets, whilst preserving frontline services. A budgetary WTE tracking system was initiated, whereby the nurse managers are allocated set hours which are tracked weekly. This system has its challenges at times where there are staffing crises or unforeseen circumstances, however, the services rose to the challenge and maintained high levels of care. Another challenge this year was the Haddington Road Agreement which brought about changes in rosters for nurses and Allied Health Professionals but with the commitment of all staff these changes were implemented in a timely, co-ordinated and committed fashion. Some staff were also faced with cuts to annual leave, pay and sick leave entitlements but have remained positive and focused on patient services. A further challenge in 2013 was the restructuring of services which included the integration of social work, physiotherapy, pastoral care and nursing services. The aim of this was for further collaboration and enhanced communication between clinical services. It is expected that the new structures will be reviewed in 2014. Quality & Risk The ongoing dedication of the team to quality, risk and patient safety has been enormous. The risk committee has strived to review each incident, monitor trends and prevent harm through recommendations. An identified gap for the group was the lack of feedback to staff across the hospital, therefore to share knowledge and initiatives the “risky business” bulletin was introduced. The bulletin is bi-monthly; it reports on trends, makes suggestions for improvement and aims to build a transparent culture of safety. We also took part in a national KPI pilot programme in relation to falls. Additionally, in an attempt to become increasingly active in the area of quality, a Multidisciplinary Team quality group was established. The group initially agreed a terms of reference for the work, devised a database to record all quality initiatives with the service and began to audit Marymount against the HIQA standards for better safer healthcare. The health and safety committee also continued its development and to build knowledge in this area, two representatives were voted as Health and Safety representatives and undertook training in the area.

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Developments In practice development the hard work continued including a full documentation audit, training and policy review. One of the highlights of the year was the initiation of an IHI programme, whereby 10 persons undertook huge commitment to complete an online programme focusing on leadership, quality and safety. The initiative was funded by HIQA’s patient safety directorate, led by Marie Kehoe-O’Sullivan. This course involved the completion of a project which was presented at the graduation to a number of people including the Minister for Health, Dr. James O’Reilly. Service changes included the re-organisation of respite patients through the NHSS office from January. This led to a more streamlined service and collaboration with the respite co-ordinator was integral. Additionally, the Department of Health introduced a charge for respite patients after a period of 6 free weeks. The charge was set at €175 per week and we adapted to the changes smoothly. Staff Two of our Registered Nurses resigned across the service. Additionally, three Health Care Assistants resigned. We were sorry to lose so many great team members but equally were delighted to welcome four new Registered Nurses to the hospital. We wish them all the very best for the future. On Foundation Day the following staff members received their gold pins for 25 years service; Elaine Ring, Veronica Morris, Cathy O’Leary and Marie O’Shea. The loyalty and dedication shown by these staff is hugely appreciated and they are thanked sincerely for such an enormous contribution. The commitment to learning has continued amidst the challenges with 3 Registered Nurses completing the Post Graduate Diploma in Palliative Care and 1 Registered Nurse completing the Post Graduate Diploma in Gerontology. This is in addition to a large attendance at mandatory training, professional development training and conferences. Throughout the year, the individual dedication and hard work of all staff was demonstrated across the organisation. Without such collaboration and commitment the work undertaken to meet the needs of the patients would not be possible. We look forward to further developments and expansion in 2014. Sarah McCloskey Director of Nursing & Allied Health

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Service Activity. The overall activity in the Specialist Palliative Care Service and the Service for Older People is outlined below and some disciplines provide additional information with their submissions.

Specialist Palliative Inpatient Unit.

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The bed occupancy in 2013 was 95%, whilst the number of new male patients was 226 and the number of female patients was 250.

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Service for Older People.

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13

St. Luke’s Day Care Unit.

2012 2013

Number of Patients who attended from home 104 101

Number of Attendances from home 1378 1169

Number of Attendances from In Patient Unit 284 306

Number of Sessions 197

Discharges 22 36

Deaths while registered as Day Care patient 49 49

Statistical comparison to 2012:

15% reduction in Day Care visits from home

7% increase visits from the inpatient unit

63% increase in patient discharges from the Day Care service

Patients are discharged routinely from Day Care when further specialist palliative care involvement is not required. Patients, who are clinically stable, in the main, do not miss their appointed day. However, less well patients are, at times, unable to attend Day Care due to illness, acute hospitalisation or hospice admission. Up to August 2013 S/N Rachel Hyland worked in Day Care for a half day to facilitate RGN attendance at Community Palliative Care MDTs. Regrettably, due to staffing and financial constraints, these hours had to be withdrawn. As a consequence, the number of patients that could attend Day Care on a Tuesday had to be reduced from 10 to 5 from September 2013, to continue safe patient care and essential MDT meeting participation. Increased attendance from the Inpatient unit can be attributed to Day Care staff explaining individually to patients the aspects of Day Care that may benefit them to encourage their attendance. In 2013, a planner was developed, highlighting for patients, a detailed summary of activities to look forward to in Day Care on a fortnightly basis. Additionally, a separate planner has been placed in each patient bedroom, on the Inpatient Unit, clarifying the days when hairdressing and nail care are offered and also shows the regular planned activities available, such as art and music. Staff continue to celebrate all holiday occasions, the most successful of which was the Summer Party .This was held on a beautiful sunny day where patients and hospital staff partook in cocktails and finger food while enjoying the hospitality and musical talents of our Day Care staff. Photographs are now printed for patients on the day an event takes place which ensures a lasting visual memory for themselves and their families. Day Care is committed to education and the development of policies to enhance patient care. Although a small department, Day Care has continued involvement in the formulation of hospital policies, which, in 2013, included Medication Management in Day Care, Intermediate Palliative Care respite, Lone Workers and Complementary Therapy policies. The promotion of and education regarding Day Care and Complementary Therapy has been through formal presentation at lunchtime lectures, presentations to external and internal groups in the Education Centre and presentation at the Journal Club. Eadaoin O’Donovan S/N has completed a venepuncture course, and now takes bloods as medically ordered in Day Care. Lynda Murphy CNM2 has developed an audit standard, a data collection tool and an audit tool for Protected Mealtimes the aim of which is to improve the mealtime experience for patients attending Day Care. This standard and tools will be used to guide and audit clinical practice with the commencement of Protected Mealtimes in Day Care from January 2014, The multidisciplinary planning for Dr Browne’s Pain Management Clinic continued in 2013 to progress the work already completed in 2012. Preparation included the identification of equipment, stores and medication requirements for the Treatment Room and the Day Treatment Room. Furthermore,

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development of documentation and sourcing of staff for the clinic has been on-going. Interventional procedures for pain relief such as nerve blocks and epidural injections will be carried out in Dr Browne’s clinic which will hugely benefit patients in the hospice, as currently transfer to an acute hospital is required for these. Lynda Murphy CNM2

Community Palliative Service. The purpose of this report is to depict the level of activity of the Community Specialist Palliative Care Service for the total Cork area from Jan 1st to Dec 31st 2013.

Number of Referrals

North Cork

North Lee

South Lee

West Cork

Total

New

referrals

2012 2013 2012 2013 2012 2013 2012 2013 2012 2013

174

181

228

276

315

331

192

187

909

975

Re-referrals

2012 2013 2012 2013 2012 2013 2012 2013 2012 2013

24

4

31

43

77

54

21

20

153

121

0

50

100

150

200

250

300

350

North Cork North Lee South Lee West Cork

No. New Patients Referred

2008

2009

2010

2011

2012

2013

15

Source of New Referrals

North Cork

North Lee

South Lee

West Cork

Total

GP

67

76

85

73

301

Consultant

114

200

246

114

674

A total of 975 new referrals were received in 2013 versus 909 received 2012

301 referrals originated with the patient’s General Practitioner within 2013 – an increase of 53 on 2012

674 referrals originated with patient’s Hospital Consultant – an increase of 13 on 2012

There were 121 patients re-referred to the service during this period.

69 new patients referred to the service, died before they were seen.

Number of Deaths & Place of Death

North

Cork

North Lee

South Lee

West

Cork

Total

Total 158 231 292 170 851

At Home 68 96 77 72 313

In Hospice 24 68 93 13 198

In General Hospital 16 26 58 48 148

In Nursing Home 20 22 37 18 97

In Community Hospital 30 19 27 19 95

Number of Discharges

North

Cork

North Lee

South Lee

West Cork

Total

2013 25 70 107 37 239

2012 32 67 124 38 261

2011 26 62 97 41 226

2010 29 61 75 18 183

2009 15 36 42 29 122

2008 10 55 67 31 163

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Population 2011 Census

North Cork

North Lee

South Lee

West Cork

Total

Population

89,438

181,400

190,885

56,405

518,128

% Increase since 2006 Census

10.7%

8.2%

6.5%

5.3%

8.33%

The National Advisory Committee on Palliative Care (2001) recommended a minimum of 1 WTE C.N.S. post per 25,000 population.

Currently, we have 15.5 W.T.E. CNS posts.

The above is a shortfall of 5 WTE on our current staffing levels based on the National Advisory Committee’s recommendations.

Audrey Allen Co-Ordinator of Community Palliative Service.

Paramedical and Pastoral Services.

Bereavement & Family Support Services. The following is the report for 2013 from the Department of Bereavement and Family Support. Psychosocial Support & Family Meetings Part of our brief on the palliative care team is to work with families who are trying to adjust to all the consequences of illness and impending loss, i.e. with practical, financial, legal, social and emotional issues. An early referral to our service allows us to work with them in a systematic way to help them deal with their immediate difficulties, plan for their future and to manage their many roles as partner, parent, carer, breadwinner, etc. We do this on an individual basis with patients and carers and also with families. We network with the multi-disciplinary team in an advisory capacity, supporting and facilitating our colleagues in their contact with families around psychosocial issues. We also do direct individual work and joint work with other members of the team. One such example of joint work with members of the multi-disciplinary team on the in-patient unit is family meetings which are an important aspect of our work in preparing families to deal with impending loss, discharge or planning for the future.

Table 1: Number of Family Meetings and Number of Patients 2007-2013

Work with Young Families While we meet families in a multiplicity of circumstances we particularly aim to support those patients with a poor prognosis who have dependent children. During 2013 we worked with many families with children under the age of 18, helping them cope with the illness as it evolved and death when it occurred. We also

2007 2008 2009 2010 2011 2012 2013

Number of Family Meetings 196 170 196 197 160 164 151

Number of Patients 156 143 163 145 130 135 171

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supported a small number of families where a child or young person in the family was ill or had died, four families in total.

2007 2008 2009 2010 2011 2012 2013

Number of Families with Young Children

73 86 74 66 75 83 88*

Table 2: Number of Families availing of Bereavement

& Family Support Services 2007-2013

Bereaved children are offered an opportunity to attend a bereavement programme on Saturdays which run twice a year.

2007 2008 2009 2010 2011 2012 2013

Number of Children 14 15 27 18 37 26

Number of Groups 2 2 2 2 3 3 3

Table 3: Children’s Groups This service is run by a member of our own department and an experienced youth worker. We would like to acknowledge the support of the Family Support Agency, Tusla in this area of our work with families. Their support ensures that we can continue to access expertise to supplement our own knowledge and skills and can provide families with appropriate materials in helping them understand and gain some control of their situation. We also work on an individual basis with some children to help them adjust to parental illness or death. Occasionally, families return to seek further support some years after a death as bereavement related issues can re-emerge. The new facility has a specially designed children’s room which greatly enhances the service we can offer to them. During 2013, we offered a direct service to 35 children from 32 families, 101 events. *(in 3 cases, the patient was a child)

2008 2009 2010 2011 2012 2013

Direct Work with Children

22 19 29 40 28 35

Table 4: Direct Work with Children Young Widowed Person Support Group Young widowed men and women are also offered an opportunity to attend a monthly support group. There they meet others in a similar situation in a safe and confidential environment and can discuss managing their own grief and that of their children. This group is co-facilitated by a volunteer who was widowed some years ago and attended a support group himself.

2007 2008 2009 2010 2011 2012 2013

Young Widowed Persons’ Support Group

5 10 10 15 16 12 11

Table 5: Young Widowed Persons’ Support Group

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Bereavement Support We provide a bereavement support service to adults bereaved of a parent/spouse/sibling/child. Some self-refer for support, others are referred by GPs, psychiatric services, by public health nurses, family members, or other members of the palliative care team.

2007 2008 2009 2010 2011 2012 2013

Bereavement Support 35 51 55 81 54 96 87

Table 6: Individual Adult Bereavement Support Education & Research Education is a core function in Specialist Palliative Care. During 2013 we participated as educators in the Higher Diploma in Palliative Care (UCC); the Introduction to the Fundamentals of Palliative Care Courses and in the module on Palliative Care for medical students (UCC). We continued our participation in a multidisciplinary project in conjunction with Milford Care Centre on best practice in family meetings. One of the social workers began study for a Certificate in Children & Loss (IHF & RCSI) in 2012 and completed the course in 2013. As one member of the team finished a term with the IAPC Education and Research Committee, a second social worker became involved in 2013. One member of the team is on the Examinations Board of the Masters in Bereavement Studies (IHF & RCSI) and is also a Board member of EAPC. One member of the team attended the inaugural meetings of the newly formed Irish Childhood Bereavement Network. Irene Murphy Director of Bereavement & Family Support Services.

Chaplaincy.

2011 2012 2013

Sacrament of The Sick 218 298 308

Chaplain present at time of death 68 83 99

Prayer Service with families following deaths or Later in the day

47 86 67

Rosary in Mortuary P.C. 27 32 27

Rosary in Mortuary Service of Older people 3 5 15

Removal from mortuary P.C. 26 35 32

Removal from Mortuary Service of Older people 6 5 14

Cremation Service 1 3

Entire Funeral in Mortuary 2 4 1

Service for Burial of Ashes 1

Grave side service PC 1

Graveside Service for Service of Older people 1 1

Private Removal of remains after 5 p.m. 11 33

Chaplain visit to patient 372/411 423/495

Chaplain support family 329/411 367/495

Chaplain support families prior death 282/350 187/384

Chaplain support families after death 165/350 296/384

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We had some staff changes, as we expected the second palliative care ward to open we needed more than one priest so that a priest would be available each day so we now have two priests each. One full time Chaplain reduced her hours to a part-time basis until the second ward became fully operational. The Church of Ireland now are involved in a more structured way 6 hours each week. Early on in the year we held a multidisciplinary meeting to review our Bereavement Service. We made a number of changes to the format and decided to have four services and moved away from the Hospital/Hospice. We were warmly welcomed by the Parish of the Church of the Descent of the Holy Spirit at Dennehy’s Cross which seats close to 1000 people. We are indebted to the Cork Farm Centre HSE South and, UCC/Presentation Sports grounds and Church grounds for so graciously making their parking available to us for the four evenings per year. The ambience of the Church was a much more fitting venue for the Bereavement Services. In June we had a wedding in the Oratory for the daughter of a patient in the Hospice, facilitated at very short notice by our own Parish of Curraheen and Midleton Parish which is in a different Diocese. A small reception followed in the Ward Dayroom and was organised by the family. In September, we had a Wedding Blessing plus Mass for the son of one of our residents, the family hosted a reception in the Activities Department. Sr. Nan O’Mahony Head of Chaplaincy

Physiotherapy. Palliative Care Service We commenced this year with a full staffing complement (albeit at a level below the recommended minimum staffing levels outlined in the report of the National Advisory Committee in Palliative Care, 2001) as the senior physiotherapist who was on leave of absence, was replaced with a basic grade physiotherapist. The positive impact of being granted locum cover is reflected in the table below. Table to show breakdown of clinical activities in the palliative care physiotherapy service 2013

ACTIVITY No. of Patients 2012 No. of Patients 2013

No. of New Inpatient Referrals 195 271

No. of Follow-Up Inpatient Treatments

1223

1574

No. of Patients Receiving Individual Treatment in Daycare

6

28

No. of Follow-Up Treatments in Daycare

7 65

Attendance At Family Meetings 36 82

There was an increase of 39% on the number of new patients seen in the inpatient palliative care unit (this is also an increase of 25% on the figures for 2011) and an increase of 29% on the number of follow up treatments provided for this cohort. In 2012, we carried a deficit of 1.0wte senior post for a large part of the year and a deficit of 2.0wte senior posts for a two month period. This had a direct negative impact on the number of patients that we were able to review and strict prioritisation was necessary to ensure that those with the greatest need received our care.

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Most significantly, by continuing this approach in 2013, we were able to increase our input into the daycare service. This resulted in a 366% increase in the number of new patients reviewed and a 928% increase in follow up treatments provided for this cohort. Our attendance at family meetings also increased by 128%. If staffing levels allow, we would aspire to expand our group sessions (both exercise classes and education interventions) in the coming year. It is acknowledged that financial constrictions are the main factor in the lack of provision of locum cover but looking to the future, it is prudent to give consideration to safe and appropriate staffing levels, if we wish to maintain consistency of high quality service and job satisfaction for staff. However, the opening of the second palliative care ward, with 20 extra beds, without a corresponding/proportionate increase in staffing levels, is planned for March 2014. It is likely that this will influence the delivery of services for the coming year. The Care of the Older Person Service Following the result of a survey by a staff member as part of her Masters, it was identified that a lot of time was being spent assessing respite patients, many of whom required no follow up. This became problematic in terms of service delivery, when turnover increased and length of stay was reduced, therefore it was decided to continue to operate a blanket referral system for any new continuing care residents, but only to assess the respite admissions if a specific concern was highlighted (respite patients have access to the community physiotherapy services). Subsequently, the method of recording physiotherapy stats in the care of the older person service was changed, making it difficult to make an accurate comparison year on year. Table to show breakdown of new referrals to the Care of the Older Person Physiotherapy Service

Year 2012 2013

No. of New Referrals 413 298

This is one of the factors that account for a decrease in new referrals (27% overall) and the time that has been created by this approach has been reinvested in group work (circuit class and ‘Go for Life’ class). Another factor is that one of the team was involved in manual handling training, which occurred more frequently during 2013. One staff member completed her MSc in Older Person Rehabilitation and we continued our commitment to education, both as educators and recipients of education, internally and externally. Siobhán O’Mahony Physiotherapy Manager

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Administration. New Initiatives. West Cork Community Palliative Care. Funding was provided by Bantry Hospice Project in 2013 for additional secretarial support to the West Cork Community Palliative Care Service. The 5 Clinical Nurse Specialists had the benefit of 25 hours secretarial support, five days per week from June 2013, provided jointly by Carmel O’Brien and Fiona Collins. Community Palliative Care. Fionnuala Hickey and Liz Sinclair gave an excellent presentation on the role of the Administrator in the Community Palliative Care Service to the Clinical Nurse Specialists and members of the Community Palliative Care Review Group. Their presentation highlighted their commitment and dedication to the service and that patient interaction is the reason why they go the extra mile every day. Hospitality Volunteers Four new Hospitality Volunteers commenced their new roles at the Hospital’s main reception on the 30th April 2014. The Hospitality Volunteers are based at reception from 11am to 4pm, five days per week. Their role is to support the receptionist on duty and to assist with visitors to the reception desk, to greet all visitors to reception, escort first time visitors to the respective wards and other departments and to handle general enquiries made at the reception desk. This initiative had been a fantastic success since its implementation. An audit of activity at reception was completed early in 2013, and focused on the various activities at reception over a 7 day period. The audit revealed the following:

65% of the receptionist’s time is spent on the telephone, whilst 36% of their time is spent on enquiries at the reception desk.

A total of 1,033 external calls to the Hospital were dealt with by the reception team over the 7 day period. This will increase significantly with the opening of the 2nd palliative care ward.

The busiest times for calls to the Hospital were 10am to 11am and 2pm to 3pm each day.

The reception team dealt with over 200 general enquiries at the reception desk over a 7 day period.

Rebranding One of the most significant projects during the year was the preparation and planning for the change of the hospital name from St. Patrick’s Hospital (Cork) Ltd. to Marymount University Hospital & Hospice in 2014. Staff in the Administration Department played a key role in ensuring the roll out of the new brand. An implementation plan was formulated and a number of meetings were arranged to ensure that all of the relevant requirements were in place for the changeover on the 8th January 2014. Education/Training. Staff members participated in a one day programme run on communication & end of life care called “What Matters to Me:, a Masterclass in Records Management in Healthcare a “Medical Secretary Refresher Master Class” run by CMG Professional Training, and mandatory training such as fire training and manual handling. We also facilitated two personnel on work placements who were partaking in a Fetac Level 5 Office Administration and Medical Administration Traineeships. Policies.

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The Communication Policy, Standard Operating Procedures for Hospital Reception and Healthcare Records Policy were updated to reflect a change in operations following our relocation.

2013 Staff Review.

Post Category Status

HR/Payroll Co-Ordinator Maternity Leave Replaced

Secretary to the Service for Older People Secondment Replaced

Project Administrator – 2nd Palliative Care Ward New Six month contract

Relief Receptionist Retirement Replaced

Irene Hegarty Head of Administration.

Catering & Housekeeping.

2013 was the year we entered & won our 1st Award! We won the Hotel & Catering Gold Medal Award for best Institutional Catering in Ireland, competing against many other hospitals, nursing homes & colleges.

The task of managing the Vending Snack & Coffee machines around the Hospital has been transferred from Catering to the new Shop.

We introduced a Sandwich Bar in the Dining Room just ahead of the lovely summer. It has proved very popular with a range of fresh sandwiches, rolls & wraps made to order on offer.

I completed a FETAC Train the Trainer course & now carry out Food Hygiene Certificate Training in house.

In compliance with the Environmental Health Officer guidelines we had to work closely with the wards in curtailing the re-heating of meals at ward level. Guidelines were also devised in relation to food brought in from outside of here to our Patients & Residents.

Catering & Housekeeping Statistics

Criteria 2012 2013

No. of staff at year end 39 41

Price of main course in Restaurant: Staff €5 €5.50

Price of main course in Restaurant: Non-Staff €7.95 €8.25

Daily Highest Restaurant Takings €811 €895

Marie Foster Catering & Housekeeping Supervisor.

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Portering Service. The Portering Service Department provides a frontline service to patients, visitors, staff and other health service users and a responsive support service to all departments in the hospital. Statistics Training:

Manual Handling 100%

Hand wash 100%

Fire Training 100%

Elder Abuse Awareness 100%

Staff Changes 2013 saw the continued rotational kitchen roster of the 4 porters. It was anticipated that with the opening of the second palliative care ward this rotation would come to an end. However, with the announcement of its expected opening it was agreed that there would not be a sufficient amount of excess work created from this opening to justify the porters being relieved of their kitchen duties. It was then agreed that one porter would carry out this work and the rotation would come to an end. As Martin McGrath was the last porter hired it was decided that this criteria would be used for selection and in June he took on role of kitchen porter on a full time basis (with the exception of Tuesdays where Martin will be involved in the maintenance of the garden). James McCarthy (a former employee of St. Patrick’s) joined us through the Community Employment scheme for a period of one year to help with the gardening duties. Policy & Service Developments With Martin McGrath carrying out gardening duties on a Tuesday and with James McCarthy carrying out regular gardening duties the Portering Department took the on the responsibility of grass cutting at the new Curraheen facility. A ride-on mower was purchased and the grass was cut on a weekly basis. Services Challenges & Responses Nil Significant Points Nil Tony Hallahan Head of Portering.

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Human Resources Purpose To ensure that our service recruits, selects, contracts, inducts, manages, informs, trains, regulates, supports, protects, records, aligns, and appraises each employee to deliver on organisational goals.

Team HR Team 2013: Hugh Morley (HR Manager), Yvonne Cummins(P/T), Louise Wolfe(P/T)=WTE of 2.4

Work Area Activities

Sta

ffin

g

Recruitment 7.5% annual Turnover Rate

In December 2013 we had 213 paid Whole Time Equivalents

16 joined in 2013 (inc 4 Nurses, 4 Catering/Housekeeping, 1 HCA)

16 left in 2013 (inc 4 Nurses, 7 HCA, 2 Catering/Housekeeping)

Church Of Ireland Chaplaincy formalised @ 6 hours per week

Pension HSE VHSS Ceiling of 198 staff operated throughout 2013

Work Experience 15 transition year students were enrolled and supported

Volunteers Approximately 190 report to Ms. Noreen Smiddy who reports to HR

FAS CES (Kay) Busdriving, gardening and daycare services continued / expanded

Em

plo

yee

Rel

atio

ns

Communications Pink Patarazzi, our bimonthly newsletter was published 6 times

Have Your Say suggestion scheme – 106 received, 70% closed

Teamtext facility introduced to all staff on a voluntary basis

Disciplinary 3 formal Disciplinary cases were held

Grievances 3 formal Grievances were processed

Events Children’s Xmas Party & Foundation Day events were held

Industrial Relations Haddington Road implementation resulted in €52K cuts for 2013

1 Labour Court hearing (Twilights) & 1 LRC mediation took place

Meetings with SIPTU, INMO, Impact held on multiple occasions

Hea

lth

& S

afet

y Employee Wellbeing

Palliative Care Supervision was organised and paid ongoing

The Employee Assistance Programme was renewed & extended

Risk 1 reported theft & 6 reported work-related injuries supported

Training Manual handling training (incl volunteer staff) was held ongoing

Fire Training was updated for hospital

Man

agem

ent

Representation HR represented at Executive, Board, Mission and Risk committees

Development Little activity in Management Development - budget constraints

Reviews Performance Review process was designed & agreed by PR group

Strategy Rebranding project for the service was agreed and rolled out.

Policy Recruitment & Garda Vetting policies were initiated for HIQA

Dat

a

Absenteeism 5.2% excluding staff on long term illness, value circa €580K

Leave Management Full leave details managed for all staff inc Haddington Rd changes

Personnel Files HIQA: 82% staff compliance. Not adequate for inspections.

Systems Reviewed Time & Attendance software for implementation in 2014

Hugh Morley Human Resources Manager

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Volunteers. We are continuing to receive applications for volunteering, however we have a very loyal team currently in place, and as we have settled into our new premises demand from departments continues to grow. The challenge for 2013 is to maintain and to continue to support the existing team which currently stand at 230, while developing and filling new volunteer opportunities. We expanded the maintenance and portering departments with new volunteers and reception cover was introduced in the Marymount ward for Saturdays and Sundays. Role descriptions are being finalised for hospital escorts, a new venture for our organisation. The introduction of main reception hospitality volunteers commenced very well and has expanded to five days a week. Two new volunteers in the Community Palliative Care department have been organised to compile charts both for the Community Palliative Care Service. As each department expands its services so does the demand for volunteers. Each department identified new roles for volunteers during 2013 and this has lead to an increase in numbers in all departments within the Hospital/Hospice. The volunteer focus over 2013 has changed to a more proactive approach. Volunteers are now asked about how best their talents/life skills can be utilised and where possible a volunteer is placed in an area in which they may have an active interest. This leads to many possibilities opening up and ensures that volunteers are actively challenged in their work. Three meetings for the Hospice Volunteer Co-Ordinators took place in 2013 one at a neutral venue in Athlone with the others hosted by Milford Hospice, and Our Lady’s Hospice in Blackrock. Volunteers are a special group of individuals who are motivated by willingness to help and a desire to spend time helping. They invest much both personally and emotionally in our service. Their contribution is acknowledged each year at a Christmas party held in their honour and they deserve the admiration and respect of all of us who work with them.

Noreen Smiddy Volunteer Co-Ordinator

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Education. In January 2013, the education centre was dedicated to Mary Aikenhead, foundress of the Religious Sisters of Charity in recognition of their role in the development of St. Patrick’s Hospital/Marymount Hospice. An inscribed plaque was unveiled as well as some large poster prints of the life story of Mary Aikenhead. The staff of the education department continues to strive to achieve the aim of facilitating the professional and personal development of healthcare providers. This is undertaken through the provision of academic education, continuing professional development education and in-service education both on-site and as outreach programmes across the HSE South. The education centre also provides sessions to the general public such as schools, care groups etc. Usage of facilities The facilities available in the education centre include an auditorium, lecture room, tutorial room, library and offices. The activity levels in the department continued to increase in 2013, with seven thousand and thirteen people utilising the classroom facilities, an increase of 8.27% on the numbers utilising the rooms from 2012. The rooms were used for education and training, for meetings, presentations, launches and also by external groups who hire the rooms. Academic Programmes Staff from the organisation were facilitated to attend academic programmes/modules in 2013. The initial cost outlay was €26,680; however, €26,080 was reimbursed from the Nursing Midwifery Planning and Development Unit. A total of sixty five study days were provided for these programmes. This was a decrease of 12% from the number of academic days facilitated in 2012. Another staff member commenced a PhD in UCC. The second year of the Postgraduate Diploma in Palliative Care commenced in Autumn 2013. This is a two year part-time programme held in association with the School of Medicine, UCC. All lectures were held in the Education Centre for this resource intense programme. Lectures were also provided to undergraduate and postgraduate Nursing and Medicine UCC programmes as well as Module IP5001 which is a stand-alone module on the Holistic Approach to Palliative Care. This academic module is offered as an option for healthcare professionals undertaking continuing professional development to obtain 5 academic credits from UCC. Continuing Professional Development Programmes Eighty nine staff members were facilitated to attend continuing professional development courses accounting for one hundred and sixty seven study days at a cost of €5,225. This is a 2% increase in the number of study days provided, a decrease of 53% in fees utilised and a 7% decrease in staff numbers attending CPD courses from 2012. The Education Centre provided continuing professional development programmes in Cork, Kerry and Waterford in 2013. A variety of programmes are offered which range from 1 to 5 days. There was an increase of 45% in the number of attendees at these CPD programmes in 2013.

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In-Service The in-service programmes continued within the organisation. The Journal Club accounted for four hundred and seventy one staff hours which was a 61% increase on numbers attending in 2012. The Tuesday Lunchtime Sessions showed a 17% decrease in attendance in 2012 with five hundred and forty one staff hours facilitated in 2013. One hundred and fourteen staff hours were facilitated for the UCC Grand Rounds and thirty eight hours for the RCPI Master Classes. Other in-service programmes facilitated were the Crisis Prevention for Community Palliative Care (110 staff hours), Staff Induction Programmes, Hand Hygiene, Syringe Drivers, Blood Transfusion, Medication Management, IV & Anaphylaxis, Central Venous Access Devices, Infection Control, Healthcare Assistants Programme, Housekeeping & Catering Training, Medical Students etc. Student Placements One hundred and six clinical placements were facilitated in the organisation in 2013 of which 91% were from undergraduate programmes and 9% from Postgraduate programmes. The placements were co-ordinated through practice development and ranged from one day to five weeks. Posters/Publications/Research Staff developed and presented sixteen posters and gave six presentations at national and international conferences in 2013. Seven journal articles written by staff were published. International Conference Marymount University Hospital and Hospice plan to hold their first International Conference in Autumn 2015. The organising committee for the conference was formed and commenced working on this exciting initiative. Education Network The education department is part of the All Ireland Institute of Hospice and Palliative Care Education Network and was involved in the development of an outline plan for the development of e-learning programmes by members of the network to commence in 2014. Library From the period of January to December 2013 the library received a total of 875 queries from staff and students undertaking placements or programmes through the Education Centre. The majority of queries received are with regard to document supply which involves supplying articles, guidelines and reports etc.

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Training is also provided by the library service and can be either on an individual basis or in a group session. Training is provided in how to search the literature within Pubmed, CINAHL and the Cochrane library databases. Library induction is run throughout the year for any new staff or group of students attending courses in the Education Centre and instruction is given on the Vancouver Referencing system and Microsoft Windows. Journals In 2013 the library subscribed to 19 specialist palliative care, bereavement care and care of the older person journals, 14 of which are now accessible online. The electronic database CINAHL was upgraded to allow full text access to a number of other relevant journals. Ebooks New ebooks are being continually added to the Myilibrary Ebook platform. The library now holds 8 downloadable ebooks. 306 remote accesses were made to the library resources. 52% of which were made by students attending courses in the hospital the remaining 48% were made by hospital staff.

User Groups Total Accesses to Library Resources

Percent

Holistic Approach to Palliative Care

91 All students 52%

PostGrad Dip in Palliative Care 32

UCC Module MX3008 35

Staff 148 48%

Total 306 100%

Website The librarian was involved in the revamp and relaunch of the new hospital website which went live in 2013 and who continues to edit and manage this. Staff The activity levels in the Education Centre had increased from 2012 and this would not be possible without the commitment of the Staff of the Education Centre. Michelle Cullen, Administrator to the Department, Aoife O’Connor, Librarian. I wish to thank the Education Staff for their commitment to their own specific roles, to the Education Department and to the organisation. The staff are continuing to provide all services whilst also endeavouring to develop other programmes. At this stage further resources are necessary for development of the service. Gerardine Lynch, Director of Education

Types of Queries Number Percent

Document supply 663 76%

General queries 79 9%

Literature Search 103 12%

Training 30 3%

Total 875 100%

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Finance. Activities. 2013 saw many changes in the life of St. Patrick’s Hospital (Cork) Ltd. The hospital produced a Strategic Plan for the first time in its history, to map the development of services now that the transition period following the relocation of services to Curraheen was over. At the same time, a management review took place to ensure that the hospital management structures were appropriate for the challenges of the new era. The rebranding of the hospital as Marymount University Hospital & Hospice, which underlined the prevailing spirit of renewal, energy and ambition, was planned throughout the year, and the changeover early in 2014 was seamless as a result. A new website complemented the change of name, and properly reflected the new professional image of the hospital. Standards of care and service in the hospital continued to be high in 2013, witnessed by a very satisfactory and complimentary report from the Health Information & Quality Authority following an unannounced inspection in September, and the winning of the gold medal in the 2013 Hotel and Catering Review for Best in Institutional Catering. The hospital also committed to the Statement of Guiding Principles for Fundraising during the year. The hospital finances continued to be under pressure in 2013. Analysis showed that the Service for Older People was loss-making, due essentially to a non-commercial rate for the Nursing Home Support Scheme continuing care beds. That rate will fall for re-negotiation in 2014. Preparations for the re-designation of six respite beds as continuing care beds were made, with the change to be effective from 1st January 2014. A third consultant in palliative medicine post was created in 2013, and filled on a half-time locum basis pending interviews in 2014 for the substantive post. Negotiations for the opening of the second palliative care ward were successfully concluded during the year, but due to the stringent employment controls in the public service, the staff in the new posts were not granted access to the Voluntary Hospitals Superannuation Scheme, and a defined contributions scheme had to be established instead. This effectively ensures that the additional beds could not be brought on stream until 2014. The hospital established Patluke Ltd. as a subsidiary company to separate the business of the Wellington Road property from the day-to-day operations of the hospital. BUSINESS REVIEW 2013 2012 € € Loss on ordinary activities before exceptional item (336,740) (380,341) Exceptional item – impairment of fixed assets _______- (1,396,724) Loss on ordinary activities (336,740) (1,777,065) The loss for the year is after a subsidy of €1,107,858 (2012: €1,144,544) and a donation of €75,000 (2012:€75,000) received from fundraising (including the Friends of St. Patrick’s).

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(FUNDS FROM FUNDRAISING INCLUDING THE FRIENDS OF ST. PATRICK’s). The following funds were received from fundraising (including The Friends of St. Patrick’s) during the year: 2013 2012 € € Subsidy 1,107,858 1,144,544 Donation 75,000 75,000 Capital Grants 677,741 1,159,490 1,860,599 2,379,034

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ST. PATRICK’S HOSPITAL (CORK) LTD.

CONSOLIDATED PROFIT AND LOSS ACCOUNT

FOR THE YEAR ENDED 31st DECEMBER 2013

2013 2012

€ €

INCOME – continuing operations 12,894,208 12,741,561 Costs Payroll and related costs 12,135,689 12,146,480 Non pay costs 2,044,317 1,896,026 Depreciation 1,690,063 1,587,947 Grant amortisation (1,560,199) (1,360,001) Total operating costs 14,309,870 14,270,452 OPERATING LOSS – continuing operations (1,415,662) (1,528,891) Donation received from fundraising (including The Friends of St. Patrick’s Hospital 75,000 75,000 Subsidy from fundraising (including the Friends of St. Patrick’s Hospital) 1,107,858 1,144,544 Other income 2,759 3,255 Investment value increase/(decrease) 4,913 1,117 Interest payable and similar charges (111,608) (75,366) LOSS ON ORDINARY ACTIVITIES BEFORE TAXATION AND EXCEPTIONAL ITEM (336,740) (380,341) Exceptional item – impairment of fixed asset _______- 1,396,724 LOSS ON ORDINARY ACTIVITES AFTER EXCEPTIONAL ITEM (336,740) (1,777,065) Taxation Loss on Ordinary Activities _______- _______- LOSS FOR THE FINANCIAL YEAR (336,740) (1,777,065) The financial statements were approved by the Board of Directors on the 20th May 2014.

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ST. PATRICK’S HOSPITAL (CORK) LTD.

CONSOLIDATED BALANCE SHEET AS AT 31st DECEMBER 2013

2013 2012 € € FIXED ASSETS Tangible assets 58,730,580 59,620,051 Financial assets 9,005 4,092 58,739,585 59,624,143 CURRENT ASSETS Stock 95,269 102,160 Debtors 1,085,236 6,467,323 Cash at bank and in hand 1,034,657 457,929 2,215,162 7,027,412 CREDITORS (Amounts falling due within one year) (2,738,196) (8,155,960) NET CURRENT LIABILITIES (523,034) (1,128,548) TOTAL ASSETS LESS CURRENT LIABILITIES 58,216,551 58,495,595 CREDITORS (Amounts falling due after more than one year) (9,452,942) (8,512,788) Capital grants (50,874,999) (51,757,457) NET LIABILITIES (2,111,390) (1,774,650) CAPITAL AND RESERVES Profit and Loss account (2,111,390) (1,774,650) RESERVES - deficit (2,111.390) (1,774,650) The financial statements were approved by the Board of Directors on the 20th May 2014.