Services In Northern Ireland Research Articles

Healthcare professionals’ attitudes towards the termination of pregnancy: a qualitative analysis of survey data in Northern Ireland

Abortion was decriminalised in Northern Ireland in October 2019. Following decriminalisation, the new regulations set out legal provision for abortion up until 12 weeks, with conditions thereafter. This cross-sectional descriptive survey, conducted in late 2019 in Northern Ireland, gathered the views of health professionals on decriminalisation, and their willingness to provide abortion services. This article provides a thematic analysis of answers to narrative questions from the online survey, and identifies priority areas of engagement with healthcare professionals. We assess how healthcare professional roles and responsibilities, abortion procedures, the foetus, and women and pregnant people were discursively constructed by respondents who are willing or unwilling to provide abortion services in Northern Ireland. We identify a narrow understanding of ‘harm’, and gendered norms of women as irresponsible or duplicitous, as inhibitory factors to the normalisation of abortion services in Northern Ireland.

Enhancing Care Planning Training for Children’s Services Social Workers in a Health & Social Care Trust in Northern Ireland—a Mixed Methods Study

ABSTRACT Care planning for Looked After Children (LAC) is accepted as being critical in ensuring good outcomes for LAC, however, the available evidence base highlights that despite the introduction of key legislation across the UK, that care planning for LAC remains inconsistent. There is limited Northern Ireland (NI) specific research available that relates to care planning for LAC; with the care planning experience of LAC being referenced in the recent review of Children’s services in NI, (Jones, R. (2023). The report of the independent review of Northern Ireland’s children’s social care services. https://www.cscsreviewni.net/files/cscsreviewni/2023-06/The%20NI%20Review%20of%20Children%27s%20Social%20Care%20Services.pdf.) which highlighted the variance in policies and procedures across the five Health and Social Care Trusts in Northern Ireland (NI), resulting in continued disparity in service delivery for children and families. The current, restricted evidence base for social work decision making in care planning, highlights practitioner’s overreliance on practice wisdom rather than evidenced-based research, theory and/or service user knowledge. This mixed methods study focussed on increasing knowledge around decision making in care planning. A training package was developed and delivered to practitioners across children’s services in one Trust area. A pre and post survey was completed with 74 practitioners in addition to 20 post training semi-structured interviews. The significant response rates and sample size offer validity and strength to the findings which correlate with previous studies completed across the UK that also conclude that research, theory and service user knowledge is not prominent in social worker’s understanding of what informs their decision making in care planning for LAC. This information is valuable for practitioners and managers attached to social work in children’s services. Recommendations include further embedding of a culture of learning and reflection to support the development of practitioner knowledge, skills and confidence; and to assist in the development of governance processes to audit the impact of practitioner training.

BS P03 The burden of bariatric tourism on the Health and Social Care System in Northern Ireland: a descriptive analysis

Abstract Background The lack of public bariatric surgical services in Northern Ireland has favoured the growth of bariatric tourism. This retrospective study aimed to analyse the data extracted from the records of bariatric patients who presented with complications to Belfast Health and Social Care Trust following their surgery abroad and investigate the costs associated with managing these complications. It also aimed to explore other factors, such as emotional trauma, that may be associated with bariatric tourism. Methods This was a retrospective study including all patients, who had their bariatric procedure abroad, presenting acutely to our hospital between August 2016 and February 2023. Data were collected from hospital records and included demographic characteristics, type of surgery, nature of complications, and costs associated with managing these complications. Descriptive statistics were used to analyse the data. Results 42 patients included in the study. Majority were female (n=35, 83.3%) with a mean age of 46.6 years. Sleeve gastrectomy was the most common surgery (n=22,52.3%), followed by AGB (n=11,26.1%), Gastric bypass (n=6,14.2%) and Gastric balloon (3,7.1%). Operations were performed in 7 countries, majority were done in Turkey (n= 22). The most common complication was leak (n=14), followed by band erosion (n=7) and nutritional failure (n=7). The total cost was estimated to be (£737,126), which includes hospital-stay costs (£553,179), non-surgical intervention (£55,607), scans (£41,728), and surgical intervention (£75,413). The total cost of dietetic inputs were about £17,390,including 410 hours. Conclusions Most patients experienced emotional trauma related to lack of adequate perioperative care, and difficulties in communication with their overseas surgeons. The results of this study highlight significant costs associated with managing such complications in Northern Ireland. The findings suggest investing in public bariatric surgical services may be more cost-effective than relying on bariatric tourism. Furthermore, Bariatric care is delivered by MDTs which are actively involved in management of these patients throughout their care-pathway. The study highlights lack of perioperative care and follow up needed to minimize complications and associated costs, as well as addressing the emotional trauma of those patients.

Knowledge and Skills for Life: School Libraries in Disadvantaged Areas of Northern Ireland

This study involved data collection and analysis from four distinct phases of research to establish the features of current provision of post-primary school library services in Northern Ireland; and how these services are being implemented in disadvantaged areas. The research also considers the challenges for school library provision, explores examples of good practice, and sets out recommendations for the future for both provision within schools and at a Northern Ireland policy level.

Provision of COVID-19 treatments to non-hospitalised patients in Northern Ireland: an evaluation

Abstract Background The first UK interim clinical commissioning policy for the treatment of non-hospitalised patients with COVID-19 was published in December 2021. A service was established in Northern Ireland, with implementation and developments overseen by a multi-agency group. We investigated the reach, uptake and equity of the programme to understand performance and offer recommendations for improvement. Description of the problem Data were extracted for 16 December 2021 to 16 December 2022. The objectives were to: 1) describe referrals over time using weekly aggregate returns sourced from the commissioning agency for all of NI and; 2) for a subset of providers, to describe treatment acceptance and those treated by age group, sex, deprivation quintile and all-cause mortality using anonymised, linked administrative data. Treatment acceptance was analysed using logistic regression. Results Overall, 16,454 patients were referred of whom 9,536 (58%) were eligible for treatment. Of these, 5,849 (61.3%) accepted, 1,215 (12.7%) declined, 1,140 (12%) were already an inpatient and the remainder unknown (1,332; 14%). Using the subset, treatment acceptance was associated with increasing age (likelihood ratio test (LRT) P = 0.02) but not deprivation (LRT P = 0.83). Of those treated (3,645 people) the majority were aged 18-64 years (68%) and were female (59%). Just 8% lived in the ‘most deprived’ quintile, compared to 20% in all others. The 28-day all-cause mortality for those recommended treatment was <1%. Lessons This was a rapidly established service which has treated 5,849 people. Acceptance of treatment increased with age but was not affected by deprivation. However, a higher percentage of those treated were from least deprived areas. Recommendations include monitoring equitability of access and a greater focus on those eligible for treatment but who decline, both highlighting the importance of engaging and empowering service users to make an informed choice around COVID-19 treatment. Key messages • Almost 6,000 people in the community have received a COVID-19 treatment since the inception of the service in Northern Ireland. • Equitability of access should continue to be monitored.

Changing trends in child welfare inequalities in Northern Ireland

ObjectivesThis study uses longitudinal administrative data to investigate the relationship between area level deprivation and the 1) referral, 2) investigation, 3) registration and 4) looked-after stages of children’s contact with child and family social work in Northern Ireland (NI) from 2010-2017 (stages 1-3) and 2010-2020 (stage 4).
 MethodsChildren’s social care data (SOSCARE database) for the years 2010 to 2020 were obtained from the Honest Broker Service in NI. The data were linked with the 2017 NI Multiple Deprivation Measure through the family of origin postcode. Cross-tabulations of year and deprivation decile were used to produce frequencies of children who experienced the four levels of intervention within each of the study years. These were then used to calculate various measures of absolute and relative inequality including the Slope Index of Inequality (SII), the Relative Ratio of Inequality (RRI) and the Relative Index of Inequality (RII).
 ResultsThere was a clear and increasing social gradient in child welfare interventions over time. Children referred to children’s social care during 2010-2017 were 4-5 times more likely to come from the most deprived areas compared to the least deprived. Despite fairly stable levels of referral inequality, the ratio of children subject to child protection investigations rose from 3 in 2010 to 6 in 2017, the ratio of children subject to child protection plans rose from 4.5 in 2010 to 8 in 2017 and the ratio of children looked after rose from 4 in 2010 to 9 in 2020. This widening inequality was largely driven by the increasing involvement of younger children from the most deprived areas in child protection and looked-after processes.
 ConclusionIn an environment of economic austerity and reduced spending, we are intervening in the lives of children and families living in the most deprived areas of NI at disproportionate rates. The current independent review of children’s social care offers an opportunity to reconfigure current provision with a clear inequalities focus.

Oral 2 - Sacral Nerve Stimulation for Voiding Dysfunction: An initial review of a regional service in Northern Ireland

Oral 2 - Sacral Nerve Stimulation for Voiding Dysfunction: An initial review of a regional service in Northern Ireland

'Nobody taught her how to be a mother': The lived experience of mothering without a mother.

Maternal grandmothers play a vital role in the transition to motherhood for their own daughters. The current study adds to this literature by investigating the lived experience of motherhood for women who lacked a meaningful relationship with their mothers. Ten mothers of children under 2 years of age participated in a semi-structured interview to explore their lived experiences of being a mother. Women were recruited from two parent-infant services in Northern Ireland. The interviews were analyzed using Interpretive Phenomenological Analysis (IPA). Three superordinate themes were identified: 'The Birth of a Mother', 'Mourning and Loss' and 'Ghosts in the Nursery'. The first theme captured the significant change of identity women experienced during their transition to motherhood. This identity change shed new light on their own experience of being mothered. The second theme captured the mourning and loss these women felt due to their relationship with their mother. Their lack of meaningful maternal relationships have left a hole impossible to fill. The final theme spoke to the intergenerational element of these mother's experience and their desire to break a cycle of maternal deprivation. The rich content from the interviews highlights the need for services to be aware of this struggle of motherhood.

Reference by the Attorney General for Northern Ireland – Abortion Services (Safe Access Zones) (Northern Ireland) Bill [2022]: The proportionality of safe access zone legislation

In an unanimous judgment given by Lord Reed on 7 December 2022, the Supreme Court of the United Kingdom (UKSC) held that clause 5(2)(a) of the Abortion Services (Safe Access Zone) (Northern Ireland) Bill is a proportionate interference with the rights of those who wish to express opposition to abortion services in Northern Ireland. This clause would make it an offence to do an act within the safe access zone with the intention of or being reckless as to the possibility of directly or indirectly influencing a protected person. In this comment, I analyse the reasoning of the UKSC. I consider, first, the clarifications offered by the UKSC on issues related to the proportionality assessment itself. I then turn my attention to the application of the proportionality test by the UKSC to the facts of the reference. I conclude that the reasoning of the UKSC in Reference by the Attorney General for Northern Ireland – Abortion Services (Safe Access Zones) (Northern Ireland) Bill is sound. The UKSC’s decision is relevant to plans to introduce similar legislation in Scotland and to any future human rights based challenges to the English and Welsh Public Order Bill, which will create a similar offence to the one in clause 5(2)(a) of the Northern Ireland Bill when it becomes law later this year. Moreover, the decision is significant because the UKSC had not previously considered the proportionality of safe access zone legislation. The Abortion Services (Safe Access Zone) (Northern Ireland) Bill has now received Royal Assent.

Women and maternity care providers experiences of planned home birth in Northern Ireland: A descriptive survey

BackgroundWhere a woman gives birth impacts both her postnatal outcomes and experiences. However, for women who plan home birth in Northern Ireland, their experiences and that of their maternity care providers are rarely sought. AimThis study examined women’s and maternity care providers’ experiences and perceptions of home birth service provision in Northern Ireland. MethodsOnline surveys were used to investigate the experiences of women (n = 62) who had experienced a home birth or had a view on planned home birth and maternity care providers (n = 77) who offered home birth services in Northern Ireland between November 2018 and November 2020. The surveys were analysed using descriptive statistics. FindingsThe women were all multigravida, with 39 experiencing a planned home birth and three having an intrapartum transfer. Most of the women (61.3 %; n = 38/62) knew about home birth services through social media or friends and 91% (n = 57/62) discussed their plans for home birth with their maternity care providers antenatally. Maternity care providers were mostly supportive (64.9 %; n = 50/77) of women having a choice about place of birth. Midwives were mostly confident (52 %; n = 13/25) or very confident (28 %; n = 7) about caring for women having a planned home birth but did not always feel supported by colleagues. DiscussionMost women rated their care as excellent or very good. Midwives reported limited support from colleagues for home birth provision. ConclusionThere is a need to support women in their birthplace choice and empower maternity care providers to facilitate this through a fully resourced home birth service infrastructure and collegial support.

Journey to Perinatal Mental Health Services in Northern Ireland

AimsThe case for perinatal psychiatry as a subspecialty is strong. In the context of perinatal mental illness consideration has to be given to; differences in presentation, the need to account for mother and baby and the risks associated with inadequate treatment. Specialist services improve outcomes, reduce risks and save money. Despite the government's agenda of preventative healthcare, service provision has been inequitable across the UK. Here we detail the journey towards the development of new Community Perinatal Mental Health Services in Northern Ireland (NI).MethodsIn NI the first embers of a perinatal service were ignited by Dr Janine Lynch approximately 15 years ago when she established a small community perinatal team in Belfast Health and Social Care Trust (BHSCT). Her commitment and foresight regarding training inspired others, resulting in high levels of interest among trainees. From this grew a dedicated group of consultants committed to supporting service development across NI.A multidisciplinary regional perinatal mental health forum was formed leading the development of a Northern Ireland Care Pathway in 2012. In partnership with women with lived experience, this forum led the bid for perinatal service development across the province.ResultsFollowing years of campaigning the need for services was recognised in both the Bamford Review (2012) and RQIA Perinatal Review (2017). A commitment for funding for specialist teams, across all five health and social care trusts, was outlined in the Mental Health Action Plan in May 2020. Funding was finally approved in January 2021.Significant work has gone into training to ensure there is a workforce ready to deliver services with focus on upskilling all professionals who deliver care to mums during the perinatal period. A competency framework has been developed to compliment this.It is important to recognise the support and commitment of many members of the college Perinatal Faculty throughout this journey.ConclusionCommunity perinatal mental health services are at an exciting juncture in NI. Each of the trusts have made a commitment to the development of services under the co-ordination of the Public Health Agency. Several have progressed to recruitment of key staff with the aspiration for services to go live before the end of the year. There will be an overarching, integrated approach, co-ordinated by the new Regional Perinatal Network.As newly recruited consultants we look forward to working in partnership to address this long-standing health inequality and improve the outcome for women and their babies in NI.

Department of Health to begin ‘emergency review' of community pharmacy services in Northern Ireland

The Department of Health in Northern Ireland (NI) is to undertake an emergency review of community pharmacy services, in response to what it says are “ongoing pressures facing the sector”. In a statement published on 18 November 2022, the Department of Health said the review would “aim to define the services that can be reliably […]

Secretary of State for Justice v A Local Authority and others: disability and access to sex workers

This is a commentary on Secretary of State for Justice v A Local Authority and others, where the decision of the Court of Protection has been overturned by the Court of Appeal. The judgment has implications for (i) the article 8 and article 14 rights of those who lack capacity to arrange lawful sexual services; (ii) the criminal liability of their carers who are enlisted to assist with such arrangements; and, potentially, (iii) the ban on payment for sexual services in Northern Ireland.

Perceptions of general dental practitioners in Northern Ireland on the clinical management of patients taking direct oral anticoagulants

##Statement of the problem Despite guidance advocating the management of patients taking direct oral anticoagulants (DOACs) in primary dental care settings, evidence from clinical audit in Northern Ireland suggested that a high proportion of patients were being referred to secondary and tertiary care settings for dental procedures with a bleeding risk. ##Purpose of the study The aim of this study was to evaluate the perceptions of general dental practitioners (GDPs) working in the health service in Northern Ireland on the clinical management of patients taking DOACs in primary dental care. ##Materials and methods: A questionnaire was distributed to the 1,167 registered GDPs in Northern Ireland, assessing perceptions of the clinical management of DOAC patients in primary dental care. The data obtained was analysed using SPSS statistical software. Qualitative data underwent thematic analysis. ##Results A total of 344 questionnaires were analysed. Some 83% (285) of responding GDPs were aware of the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance. Some 98% (337) believed that patients taking DOAC medication could potentially be managed in primary care but that additional training was required. Some 80% (275) of GDPs had referred patients to secondary care. Procedures presenting a low risk of postoperative bleeding complications accounted for 12% (41) of referrals. ##Conclusions A lack of GDP confidence and experience in the management of DOAC patients are motivating factors in referral to secondary care settings for treatment. Some 12% of the referrals analysed were potentially inappropriate, given the low risk of associated postoperative bleeding complications. Additional training and support for GDPs, as well as enhanced awareness of the SDCEP guidance, is essential.

‘All it takes is one person to stand up and make a change’

Sexual health services nurse manager Nicola Bailey defied opposition to set up an early medical abortion service in Northern Ireland

Abstract 58 - Dynamic sentinel node biopsy for penile cancer: Introduction of a new regional service in Northern Ireland

Abstract 58 - Dynamic sentinel node biopsy for penile cancer: Introduction of a new regional service in Northern Ireland

Dentists call for action as figures show full impact of pandemic on service in Northern Ireland

Dentists call for action as figures show full impact of pandemic on service in Northern Ireland

Exploring patient experiences of cancer care in Northern Ireland: A thematic analysis of free-text responses to the 2018 Northern Ireland Patient Experience Survey (NICPES)

BackgroundCancer diagnosis, treatment and survivorship is multifaceted, and the cancer patient experience can serve as a key indicator of healthcare performance and quality. The purpose of this paper was to analyse free-text responses from the second Northern Ireland Cancer Patient Experience Survey (NICPES) in 2018, to understand experiences of care, emerging themes and identify areas for improvement.MethodsA 72-item questionnaire (relating to clinical care experience, socio-demographics and 3 free-text questions) was distributed to all Health & Social Care Northern Ireland patients that met the inclusion criteria (≥ 16 years old; confirmed primary diagnosis of cancer and discharged between 1st May and 31st October 2017) in June 2018. Participants could complete the questionnaire online or access a free telephone support line if required. Open-ended free text responses were analysed thematically to identify common themes. Free text responses were divided into positive or negative comments.ResultsIn total, 3,748 people responded to the survey, with 2,416 leaving at least one free text comment (69 %). Women aged 55–74 years were most likely to comment. Overall, 3,644 comments were left across the three comments boxes, which were categorised as either positive (2,462 comments; 68 %) or negative / area for improvement (1,182 comments; 32 %). Analysis of free text responses identified six common themes (staff; speed [diagnosis and treatment]; safety; system; support services and specific concerns), which were all related to the overarching theme of survival. Staff was the largest single theme (1,458 responses) with overwhelmingly positive comments (1,322 responses; 91 %), whilst safety (296 negative comments; 70 %) and system (340 negative comments; 81 %) were predominantly negative. Negative comments relating to primary care, aftercare and the cancer system were reported.ConclusionsThe high response rate to the free text comments indicates patients were motivated to engage. Analysis indicates most comments provided were positive in nature. Most survey respondents reported a positive experience in relation to staff. However, there were a number of areas for improvement including the aftercare experience, and a perceived disconnect between primary care and cancer services. These results can help inform the effective delivery of cancer services in Northern Ireland.

Diary: Abortion in Northern Ireland

Diary:Abortion in Northern Ireland Joanna Biggs (bio) "Diary: Abortion in Northern Ireland" is a nonfiction journalistic piece written by writer and editor Joanna Biggs that was originally published in the London Review of Books on 17 August 2017 and is reproduced here with permission. It provides an account of abortion illegality in Northern Ireland, capturing the tenors and restrictive sinews of the time before the 2019 lifting of restrictions in Northern Ireland. We present it here as a snapshot of this era, with one of the aims of the diary to capture some of the different discursive registers at play, including public and media representations of abortion. Biggs's piece traces the financial, physical, and mental challenges as well as the confrontations and falsities that women in Northern Ireland are forced to face when trying to access reproductive health care and abortion services. It explores the support systems that they can utilize, including the procuring of abortion pills, and she documents some organizations in the United Kingdom that help with financial and practical travel arrangements. In this way the essay functions on a number of important levels at once: as activist journalism calling for the need for widespread abortion services in Northern Ireland; as an informational piece that provides women with some details about abortion options in a restrictive climate and place as a brief historical and contemporary account of the legal and political landscape of Northern Ireland; and as a personal reflection on storytelling and its importance as a transformative device. ________ There is one abortion clinic in Northern Ireland: a Marie Stopes clinic on Great Victoria Street, which joins the two-up two-down red brick terraces of the Lisburn Road, where Ulster banners fly from the lampposts, to the City Hall with its eau-de-nil dome and pale-stone statue of Queen Victoria. The clinic isn't easy to find: the signs beside the door at No. 14 are for BioKinetic Europe, which runs clinical [End Page 232] trials, MKB Law, and Bupa; next door there's a Tesco Express and Boojum, a "Mexican burrito bar." Danielle Roberts, an abortionrights activist with Alliance for Choice, says that on the days the clinic is open—Thursdays and Fridays from 9 a.m. until 6 p.m.—you can't miss it: members of the pressure group Precious Life are always outside. ("We are saving babies, mothers, and indeed this country from the silent holocaust that is brutally destroying fifty million lives worldwide every year.") Danielle acts as an escort for women with appointments on the eighth floor: two activists for every woman, one wearing a "body cam, as there have been assaults and harassment." Abortion, or assisting abortion, is a crime in the United Kingdom: the 1967 Abortion Act that applies in England, Wales, and Scotland gets round this with provisos that allow abortion to be lawfully performed: if the pregnancy is still under twenty-four weeks and two doctors agree that there would be "grave permanent injury" to the "physical or mental health of the pregnant woman," or serious danger to the child. In Northern Ireland, which never adopted the 1967 act, the 1861 Offences against the Person Act—the one that imprisoned Oscar Wilde—substitutes for it. Any pregnant woman "with intent to procure her own miscarriage … shall be guilty of felony … and being convicted thereof shall be liable … to be kept in penal servitude for life" (this remains the maximum penalty). There have been amendments over the years—case law shows that abortion is lawful in Northern Ireland in exceptional circumstances—but nothing to make abortion legal in cases of rape, for instance, has ever been put on the statute book, and successive iterations of medical guidelines haven't made it clear under what conditions doctors would be acting legally (or illegally) when performing an abortion. And there seems to be no political will to make the situation clear: only the Green Party and the People Before Profit Alliance support decriminalization; Sinn Fein wants "limited reform"; but the Alliance Party claim abortion is a matter of individual conscience and the DUP are openly pro-life. To make things worse...

An excellent service and a catalyst for change? The future provision of criminal defence services in Northern Ireland

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