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Press Release

Minister for Health launches Enhanced Care Model showing benefits for patients and staff

Published: 15 July 2019
From: Department of Health

Family involvement and satisfaction increases.

100% of staff trained.

€400k saving on agency staff.

Minister for Health, Simon Harris TD, today (Monday) launched the Final Report on the Enhanced Care Model, which is designed to change the way we deliver enhanced care, improve patient outcomes, reduce agency spend and increase job satisfaction for heath care staff.

The Report outlines a new model of care for patients in acute hospitals who need dedicated one to one care or ‘enhanced care’. What this means is that enhanced care will be delivered by a team of specially trained Health Care Assistants, supported by the nurses on the ward and senior nurses throughout the hospital.

It involves person-centred care being delivered in collaboration with a patient’s family, using specific initiatives such as distraction therapy, music, and other clinical resources to promote healing and recovery. The care is documented using specifically developed care plans, to ensure consistency and a person-centred approach.

Enhanced care is provided for patients who may be disoriented, have altered cognition or behaviour or a non-acute mental health illness. Preventing falls, confusion and agitation are the most common reasons that patients may require enhanced care.

Launching the report, Minister Harris said:

“This Report marks another step in ensuring that patient safety is to the fore when meeting the complex care needs for our most vulnerable patients. The continued work under the Framework for Safe Nurse Staffing and Skill Mix led by Dr Siobhan O’Halloran, Chief Nursing Officer, is indicative of this Government’s commitment to safe patient care."

The Enhanced Care Model was created using the evidence and learning arising from the implementation of the Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings. The provision of this level of care presents a significant challenge in our hospitals. The testing demonstrated the model to be an effective and sustainable approach to providing enhanced care.

Early results from the pilot project have already demonstrate positive benefits for patients, staff and the organisation. The report demonstrates that was increased family involved with patient care, an increase of 40% to 100%.

This resulted in an increase in patient and family satisfaction. 31% of staff had felt they did not have sufficient skills in the provision of enhanced care before the training programme, this increased to 100% of staff reported having sufficient skills following the bespoke training programme. One of the most significant outcomes from this report is that during the pilot project the number of agency hours used reduced by 40%, despite the 23% increase in demand for this type of care during that time period. If this model had not been implemented the increase in demand would have resulted in a projected €400,000 additional spend.

Ongoing measurement, evaluation, and dissemination of findings have facilitated staff engagement and recommendations for further development.

Minister Harris concluded:

“This pilot project has improved the way Enhanced Care is provided to patients, and I fully support other organisations adopting this model of care. I also welcome the ongoing collaboration between the Chief Nursing Office in the Department of Health in Dublin, and the Chief Nursing Office in Northern Ireland to establish shared principles and recommendations for the provision of enhanced care as part of an all-island approach.”


Notes to the Editor:

Read the Final Report on the Enhanced Care Model.

Office of the Chief Nursing Officer

In 2013, the Department of Health appointed Dr Siobhan O’Halloran as its first Chief Nursing Officer at Assistant Secretary level. This appointment will ensure that the role of nursing and midwifery is represented at the highest level in terms of policy making for the health service. The Office of the Chief Nursing Officer (OCNO) is supported by the specialist nursing and midwifery expertise of the three Deputy Chief Nursing Officers. The purpose of these posts is to maximise the contribution of the nursing and midwifery professions by driving a culture of patient safety through the development of robust systems of accountability and responsibility.

Framework on Safe Nurse Staffing and Skill Mix

The Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Adult Hospitals in Ireland was launched by Minister for Health, Simon Harris in April 2018. This framework sets out, for the first time in Ireland, the methodology to determine the appropriate number of nurses and healthcare assistants required for a medical/surgical ward based on the number of patients and their particular needs. The framework was developed based on international research, consultation with key stakeholders and was piloted in three hospital sites; Beaumont Hospital, Our Lady of Lourdes Hospital, Drogheda and St Colmcilles Hospital, Loughlinstown.


In April 2014, the Minister for Health, approved the establishment of a Taskforce on Safe Nurse Staffing and Skill Mix. The core objective of the Taskforce was to develop a framework to support the determination of safe nurse staffing and skill mix ranges (whereby nurse staffing refers to the nursing team including both the nurse and healthcare assistant roles) in a range of major specialities. Phase I focused on general and specialist medical and surgical care settings in adult hospitals in Ireland.

The Framework on Safe Nurse Staffing and Skill Mix is based on four assumptions which are as follows:

  • patient elements
  • nurse staffing
  • organisational outcomes

The approach taken to the development of this framework has been underpinned by evidence, not only in its development but equally in testing its capability to deliver in practice.

Enhanced Care

Enhanced Care refers to the need for additional or extraordinary care, beyond what is provided for within average daily staffing levels. Enhanced Care is provided for patients who are disorientated, have altered cognition or behaviour or a non-acute mental illness. The Enhanced Care Model includes various levels of care that a patient may require to support recovery or healing. Enhanced Care involves allocating a specific member of staff to a patient or group of patients with responsibility for continuous awareness of the whereabouts and care needs the patient(s) through ongoing observation (Dewing, 2013). This can vary from one-to-one care to general or cohort observation. A variety of titles are used interchangeably to describe Enhanced Care including: constant care; specialling; one-to-one care; and direct patient monitoring (Kerr et al., 2013; Wilkes et al., 2010).

The reasons patients require Enhanced Care are quite similar throughout the system, with falls and confusion/agitation being the most frequent determinants. Nursing staff can struggle to manage unpredictable behaviours where there are limited specialist resources and a lack of time to supervise patients exhibiting behaviours which are seen as challenging (McDonald et al., 2012).

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