01Annual Report 2015

02My tenure as Chair of Headway has encompassed a period of significant retrenchment in health service provision generally due to the economic difficulties faced by the country during that six year period. Services to people with brain injury, which were acknowledged as inadequate by the Department of Health and Children as long ago as 2007, have not been able to achieve the quantum improvement we might have hoped for; these years have been marked by fraught efforts to protect existing services and, where possible, to inch forward by stretching existing resources to their absolute limits.

On behalf of the management and staff of Headway, I am very proud of the manner in which we have faced these challenges.

Needless to say, everyone associated with the organisation would wish that the inadequacies identified in 2007 could have been, by now, fully dealt with; that a full continuum of services for people with brain injury would be available wherever in Ireland they were needed; that waiting lists had been eliminated; that the infrastructure for the provision of services was, in all cases, fully fit for purpose. These remain our ambitions and they will continue to underpin our strategic planning in the years ahead.

In the meantime, despite the difficulties, we have made considerable progress. Not one of our services has been diminished during this time and we have recorded a number of significant achievements, including the award of international accreditation and major improvements in our infrastructure – most recently through the acquisition of a new premises in Limerick thanks to the great generosity of the JP McManus Foundation. Through adherence to the highest standards of governance and accountability, we have maximised the outputs from revenues which not only bore the full brunt of the cuts but have been largely left behind in recent agreements to reinstate public service wages. Throughout the period, we fully met our obligation to balance our finances and maintain a prudent reserve.

This could not have been achieved without the forbearance and dedication of the Headway team. The Board is acutely aware of the sacrifices they have made in recent years as their earnings were eroded and we asked them for ever greater effort to ensure that client services were protected. They have responded magnificently. For our part, both

the Board and management are now fully focused on redressing, insofar as we can, the disparities that have resulted between the wages of Headway staff and comparable public service grades.

I am delighted that Dr. Niall Pender has agreed to take on the role of Chair and that his nomination was unanimously supported by the Board. His role as Head of Neuropsychology in Beaumont Hospital gives him a unique perspective on the needs of people with a brain injury and, specifically, the life-changing potential of the services and supports that Headway provides. I

hope and believe that we are on the cusp of a period of material progress in the provision of brain injury services and I am confident that Niall is the right person to ensure that Headway is at the forefront of any such development.It has been a great honour to serve as Chair of Headway for the past six years. My interactions with staff and clients have been inspirational

– the former continually show levels of caring and commitment that are truly remarkable and the latter demonstrate the dramatic impact on them and their families of the Headway service.

We have sought to achieve a balanced representation on the Board, which includes representatives of clients and carers as well as people with the very specific skills required to ensure best practice corporate governance and management oversight. My grateful thanks to past and serving members for their selfless contributions.Finally, I would like to acknowledge the very significant role played by Kieran Loughran, the Headway Chief Executive. His input has been absolutely crucial to everything that has been achieved.

David HoldenChairman

CHAIRMAN’S STATEMENT

“I am very proud of the way we

have faced these challenges”

Headway’s mission is to bring positive change in the lives of those affected by an acquired brain injury

03CHIEF EXECUTIVE’S REVIEW

Brain injury in all its manifestations is a life-changing event impacting on all aspects of daily activity, is seldom obvious and is very difficult to explain simply.The fact that a brain injury can affect all aspects of daily living: from getting out of to bed, to preparing for a day, to travelling alone, to planning any event, working or socialising, all while a

person can talk or look good makes it difficult for the average person to appreciate that a brain injured person’s central processing unit may be compromised.

Essentially there are two distinct types of brain injury: a traumatic brain injury caused by a fall, an assault or a road traffic accident or non traumatic brain injury caused by a stroke, tumour or lack of oxygen to the brain.

Even though Headway literature for years past has identified the distinction between traumatic and non traumatic the average person does not necessarily identify stroke as a brain injury.

Caretaker Minister for Health, Leo Varadkar, cited stroke survival rates as one of the HSE’s major achievements under his watch. Great effort and emphasis has been concentrated in developing stroke services and rehabilitation in hospitals, in certain instances to very good effect, however, when the stroke victim leaves the acute hospital having been stabilised, they do not leave the stroke behind and people are often discharged to a very uncertain and unsupported future. This places great strain and demands on their primary carer, partner or family.

A recent piece of research prepared for the Irish Heart Foundation by the Economic and Social Research Institute and the Royal College of Surgeons in Ireland supported the ambition for early discharge for stroke victims. It is suggested that early discharge will lead to better outcomes for stroke sufferers with a resultant lower cost to the health system. There is nothing wrong with the fundamental thesis except that community services do not exist to support people who have been discharged, and more importantly, the carer or significant other may not be prepared for the consequences or the family home may now be unsuitable because of impaired mobility.

Calls to Headway’s National Helpline support the case that unplanned early discharge causes untold trauma for others.

Headway is the only community service providing rehabilitation for stroke survivors that includes psychological support, for the brain injured person and their significant other, if required.

We continue to enjoy a positive relationship with our primary funders, the HSE, and we continually attempt to work with them as partners seeking solutions to the many challenges that face people with brain injury.

Our international accreditation continues to drive us towards better evaluation of outcomes.

We are well settled in Blackhall Green and we make the premises available to the HSE and other groups.We signed a contract to purchase a premises in Limerick and anticipate development in the coming year.

Intensive preparatory work has been put into our Strategic Plan 2016- 2018 and this will give us a clear future direction.

I work with wonderful, committed and professional staff and I am more than happy to repeat that annually. This sentiment is not solely that of a blinkered CEO but it is echoed daily through our clients and annually through the independent client and carer survey. David Holden made reference to the commitment of the staff through the recent difficult times and a commencement of the rebalancing of the remuneration of staff is a priority for me this year. The HSE is in a weak legal and moral position when it imposes the full range of cuts, even though we are technically outside of the statutory agreements, and then refuses to re-instate the cuts while the majority benefit. The resolution of the situation could very well be a watershed for the future of Section 39 organisations.

Being a Board member of a voluntary organisation has not been easy in the last number of years. I am very grateful to our Board for their collective commitment and for the support and guidance offered during difficult times.

As the chairman David Holden steps down, I think it is an understatement to say that David has demonstrated the following qualities in abundance in carrying out his responsibilities – leadership, thoughtfulness, total commitment, professionalism and diplomacy. Whilst the sector has been rocked by revelations over the last number of years the Board led by David has a keen sense of doing what is right, always using common sense. There are no owners of Headway but there are many stakeholders – clients, family members, the Board, staff, HSE, other funders / donors, all with a common interest – “to bring positive change in the lives of those affected by acquired brain injury”

Kieran LoughranChief Executive

04REVIEW OF OPERATIONS

The service

We had a very busy year in 2015 which saw many new clients engaging in their rehabilitative programmes

both in Headway’s training centres and in the community. Most importantly, we saw an increase in the number of early referrals, particularly from CUH, which allowed clients to gain access to appropriate rehabilitation soon after their discharge from acute services.

We held two family events over the year. An Open Day was hosted at the Carrigrohane training centre in July, and showcased all programmes. In November, we held a “Caring for Carers” day in our Ballincollig centre. Both days were very well attended and very successful in bringing

people affected by acquired brain injury/stroke together. In December, we heard the good news that we were successful in our application for the Dormant Account Fund, and over 2016 will provide a range of training to family carers to assist them to upskill for their caring roles.

We continued to represent Headway on the Boards of Employability Ireland and Vita Vivendi, and engage with a wide range of other services in our community in an effort to spread the word about Headways work.

2015 saw Headways First National Boccia Tournament with Day Rehabilitation Services in Cork being the winners. Our Social Activity Club has gone from strength to strength with 20 members.

We are grateful to Stryker who provided two days labour to tidy up the premises and outside space in Carrigrohane

Finally, a word of thanks to: our clients, their families, our staff team, our funders, supporters, volunteers and students who made 2015 yet another year in which to make a difference.

The service

The Headway Information and Support service (1890 200 278) provides an instant point of contact for anyone affected by brain injury in Ireland. Through its telephone helpline and online channels,

the service provides information, signposting relevant resources and supportive listening. The team also facilitates carer support groups in the South East region. Last year the service handled 1,389 requests, a 5% increase on the previous year. People with brain injury accounted for 31% of contacts, carers 32% and professionals 37%

respectively. Survey results show high overall satisfaction levels with the service with 98% of respondents saying they would recommend it. During the year, traffic to the Headway website grew by 10%, and Facebook reach grew by 40%. Twitter followers grew by 700 in the year.

The magazine Making Headway was produced in two editions of 1,500 and the e-zine was issued 8 times during the year. The team were active in the community, providing a total of 29 talks, presentations and information stands throughout 2015. In December, the team published the first phase of a brand new suite of information, “Living with Brain Injury”. The suite contains five information booklets, a diary/organiser and reading guide in a portable plastic folder.

The carer support groups in the South East Region: Carlow/Kilkenny, Waterford, Wexford and Tipperary South – also remained active with a total of 41 attendees.

The service

Headway Limerick offers vital supports and services to people whose lives have been affected by acquired brain injury. Our Limerick services include vocational and rehabilitative training,

day rehabilitation services, community integration, local area coordination as well as family support and education groups.

Our day rehabilitation service provides meaningful activities such as music therapy, mindfulness and app classes, from which learning is transferred to home and community life. Our rehabilitative training programme continues to support clients with social and personal skills to live as independently as possible.

Our Vocational Programme equips clients with personal and practical skills in order to progress on to employment and/or further education. This programme had great success in 2015 where 15 clients graduated with full awards in Employability Skills.

Community Integration continues to complement all services as well as meeting the objectives of New Directions. In particular, this service has demonstrated highly successful outcomes for clients on the vocational programme.

Local Area Coordination commenced in January covering the Mid-West. This pilot project is a partnership with the HSE and Acquired Brain Injury Ireland, and is being led by Headway. Hubs and drop-in sessions have been established throughout Limerick, Clare and Tipperary, as well as providing one to one support.

Rehabilitation Services and Community Integration – Cork Liz Owens

Information and SupportRichard Stables

Rehabilitation Services – Limerick Louise Carey

05The service

2015 saw the further development of psychology services in Cork and Kerry. We expanded our student placement opportunities to include, for the first time, a student from the Masters programme in Applied Behaviour Analysis in National University of Ireland Galway (NUIG). This has afforded us additional skills and resources which have allowed us to focus on specific supplementary projects such as teaching different forms of self -management and anger management skills to our clients. We also have a student art therapist on our team, which has enriched the department, allowing us to provide therapeutic services for clients through the medium of creative expression. We continue to receive invaluable input from our voluntary counsellor and voluntary psychology assistants.

The psychology department has recently undergone re-structuring. We are small in numbers we are big on innovation. Currently, we are in the process of planning some new projects which are bringing both challenge and excitement to our department. We are cognisant of the importance of communicating the nature of the work

we do in neuropsychological rehabilitation and moreover, highlighting the courage and resilience of our teachers: the clients. To this end, we will endeavour to continue to research what psychological interventions are effective, for whom and when. We continue as best we can to incorporate these learnings into our programmes while sharing them with the wider rehabilitation community through peer reviewed publications and conference presentations.

We are very much looking forward to continuing the journey of rehabilitation with our clients for the coming year 2016.

The service

2015 was another busy and productive year for Rehabilitation Services in Dublin. As always hard work and enthusiasm of staff ensured ongoing commitment to the pursuit of excellence in service provision for our clients. Ongoing review and rethinking of service provision continues to move us closer to truly person-centred service planning and provision.

Psychology

Psychological Services Dublin continues to provide a range of services, including Neuropsychological assessment, specialised psychotherapy, cognitive rehabilitation as well as support for family members/carers of those with ABI. Due to ongoing efforts at wait list management, we have succeeded in maintaining wait times of psychology services to a minimum. We are committed to maintaining these going forward.

Day Rehabilitation Service Dublin (DRS)

DRS offers slow stream rehabilitation to people who have experienced ABI. The programme aims to maximise our clients existing skills, while encouraging social participation, personal development and increasing independence. In 2015 DRS continued to provide a range of rehabilitation activities including art, cookery skills, brain injury education, as well as social outings and leisure activities to almost 120 clients we currently serve. In addition, we managed to successfully open two new drop-in day service groups, which have increased client numbers and significantly reduced wait times.

Rehabilitation Training Dublin (RT)

RT offer a programme aimed at increasing our clients functional independence in the community and improving their overall quality of life. Clients engaging in this programme are supported to pursue QQI accredited training in a variety of areas, and are encouraged to explore and develop new areas of interest. Staff and clients work together to develop a personalised timetable for each participant, which is tailored to best support them in gaining

maximum independence as well as increasing their engagement in meaningful social roles in their communities.

Community Reintegration Dublin (CR)

The ethos of the CR programme focuses on facilitating clients to participate meaningfully in their communities. This one-to-one service involves collaboratively developing a programme of social/vocational/recreational participation which supports the client in attaining more independence and increasing their sense of efficacy. This may include volunteering, a return to employment, further education, as well as leisure and recreational activities.

CR also engages in group support for clients; due to the success of the ‘Connections Club’ 2015 we opened up two more social support groups, the ‘Discover Clubhouse’ and the ‘Meet-Up’ group. Together these groups provide ongoing social support for up to 90 people who have experienced ABI.

Throughout the year staff and clients have worked together on many initiatives to increase awareness of ABI and issues affecting the lives of those impacted by it. We look forward to the year ahead as an opportunity to grow and develop supports for the people we serve.

Psychology Services Cork/Kerry/

Limerick Marcia Ward

Rehabilitation Services - Dublin

Sonya Gallagher

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Headway Key Activity Measures 2015

07

Headway Key Outcomes 2015

08OUR APPROACH TO QUALITY

Internationally Accredited Services

Headway’s Home and Community and Vocational programmes (brain injury speciality) are internationally accredited by CARF International. We continue to strive to improve the quality of the service we provide and achieve the highest standards possible. Headway is proud to currently hold the maximum three-year accreditation, the highest possible award under the scheme.

What does CARF Accreditation mean?

CARF International is a non-profit organisation that consults and advises health and human service organisations on best practice standards to improve the quality of their services. Accreditation by CARF International is official recognition that Headway is guided by internationally recognised service standards and best practices. It demonstrates commitment to the highest standard of business function and service delivery, resulting in provision of the best possible quality of service. Accreditation also demonstrates the organisations specific commitment to put the needs of its clients at the centre of everything Headway does. It illustrates the value of the input of its clients, the respect for the rights and individuality of all Headway clients and Headways accountability to all stakeholders. Moreover, it affords Headway an opportunity to engage in an ongoing quality improvement framework including consistent measurement of appropriate outcomes, that serves to better meet the needs of the clients it serves. You can find out more about CARF and their system of accreditation at www.carf.org.

Headway’s Quality Statement

“Headway is committed to continually improving our service delivery and practices as an organisation. We seek to increase the positive outcomes for clients of our services and continue to initiate new approaches in our work that can further support our mission and core values. We are committed to actively seeking information from clients, their families, employees, referral sources, funding sources and other stakeholders. We are committed to providing services in a manner that utilizes all inputs to best serve the needs of the clients we serve.”

09A CLIENT’S STORY – BY DEREK CUMMINS

For Information and support call:

1890 200 278Monday to Friday

9am to 1pm, and 2pm to 5pm Or email: helpline@headway.ie

I never realised how much life could be so good and also how fragile. In June 2013 my world was shattered. I had a stroke. I lost all the things that I loved all the pieces that made me whole. I couldn’t make sense of it.

My stroke had impacted my way to communicate – I have Aphasia, I had lost my words, I could not speak, I could not write – I was a mess. Neither my family or I could make sense of it. The pieces of my jigsaw were there but I could not find a way out. I was still here inside but I was lost.

When I was discharged from Tallaght hospital in July I didn’t know what lay ahead. How do you restart when you have a brain injury? I was given a place in the NRH (Dun Laoghaire) in October 2013 where I focused on speech therapy. I got a lot of help there! After a couple of meetings, it was felt that it would really help me if I could get a place in Headway. I had also organised a counsellor for myself from Clondalkin and this did make a big difference for me, someone to talk to and listen as I try to make sense of my changed life but being involved with Headway – The Harbour Group – was the huge step for me and I could begin my new strange world.

Headway has shown me I have a voice, I can be heard and this confidence is certainly a big part of the help I get from the team in Headway. I recently joined the choir which was something that I never thought that I could be a part of. After I had my Stroke I had lost the love of music. I can’t hear fully the beat the words or the music and yes it is hard for me but again I felt a part of something and that I could connect and that I can do this.The melodies are coming back, slowly – the beat is still there and deep inside the music is alive. Headway is helping me find some new routes and it is becoming real again. Confidence is really important and if you can believe, well you can go on.

The #ISeeBeyond campaign has been unbelievable – the team are touching people’s lives and helping hidden disabilities in an area that is only now beginning - the only word that I can say is that this is really powerful. I hope this will change the way people will think and hopefully normal people will stop and realise that they should not just make judgements.

So yes I Derek Cummins am a very lucky person, in June 2016 It will be three years since my stroke – I have done much more now than I have ever believed and the thing is so amazing is that I can still feel the fire inside me and I can go forward. I don’t know what is next for me but one of the things that I am 100% clear is that I am going the right direction.Yes there will be badness and sour places and that there will be hard times ahead and I am sure that I will fall but with strong people like my family and the support of Headway I know now that I can get through this and I will continue.

The World On My Mind

I never knew I needed wordsUntil I lost them

And now I miss them so muchThey make sense

Of my whole worldThe ifs, I’s, It’s, the us, we,

So, me, you, am, of, are, be, etcThere are the joints of letters, words, sentences,

Chapters and booksI will find you again

I promise

Derek Cummins April 2014

10GOVERNANCE CODEHeadway subscribes to the Governance Code – a code of practice for good governance of community, voluntary and charitable organisations in Ireland.The key principles of the code are as follows:

• Leading the organisation effectively• Exercising control over the organisation• Being transparent and accountable• Working effectively as a Board• Behaving with integrity

Headway’s Board and Management aspire to ensure that the organisation maintains appropriate governance structures commensurate with its operations and aligns with evolving sector standards. As such, the Board will continue to ensure that it further embeds the Code’s principles in its operations.

AUDIT AND RISK COMMITTEEHeadway’s Audit and Risk Committee meets four times a year in advance of Board meetings.The membership comprises three appropriately qualified Board members, the CEO and the Finance Manager as required.

The Terms of Reference of the Audit and Risk Committee are:

• To monitor the integrity of the financial statements of the organisation• To review the organisation’s internal financial control systems• To oversee the annual risk assessment process• To monitor and review the auditor’s independence, objectivity and effectiveness• To recommend approval and appointment of external auditors

QUALITY AND SAFETY COMMITTEEHeadway’s Quality and Safety Committee comprises three Board members, the HR Manager and Quality & Standards Manager.The terms of reference of the Quality and Safety Committee are:

• To recommend to the Board a quality and safety programme, policies and processes that clearly articulates responsibility, authority and accountability for quality, safety and risk management across the services

• To secure assurance from the senior management team on the implementation of the quality and safety programme

• To monitor and review that Headway is conforming with all regulatory and legal requirements to assure quality, safety and risk management

• To act as advocates at both Board and Government level for quality and safety issues which cannot be resolved by the senior management team

COMPLIANCE WITH THE GUIDING PRINCIPLES OF FUNDRAISINGHeadway’s Ireland Ltd resolved to adopt the ICTR Voluntary Statement of Guiding Principles for Fundraising. Headway is fully committed to complying with the Statement, which exists to:

• Improve fundraising practice• Promote high levels of accountability and transparency by organisations fundraising from the public• Provide clarity and assurances to donors and prospective donors about the organisations they

support

For full information on our donor charter, codes, policies and compliance, you can consult our website www.headway.ie or call us on 01 604 0800.

11FINANCIAL STATEMENTS

Headway (Ireland) Limited(A Company Limited by Guarantee)

Statement of Comprehensive IncomeFor the year ended 31 December 2015

Income Gross Income Administrative expenses

Operating Surplus Interest receivable and similar income Interest payable and expenses

Surplus before tax

Surplus for the financial year

Balance sheetAs at 31 December 2015 Fixed assetsTangible assets

Current assetsDebtors Cash at bank and in hand

Creditors: amounts falling duewithin one year

Net current assets

Total assets less current liabilities Creditors: amounts falling due aftermore than one year

Net assets

Capital and reservesOther reserves Income and expenditure account

Shareholders’ funds

2015 2014€ €

3,466,894 3,453,640

3,466,894 3,453,640 (3,450,842) (3,446,595)

16,052 7,045 3,440 8,142

(10,831) (12,397)

8,661 2,790

8,661 2,790

2015 2014

€ € € €

1,284,279 1,353,992

145,193 172,393 781,631 884,431

926,824 1,056,824

(566,239) (600,272)

360,585 456,552

1,644,864 1,810,544 (865,498) (1,039,839)

779,366 770,705

165,508 165,508613,858 605,197

779,366 770,705

012

The Board of Directors:Mr. David Holden (Chairperson)Mr. Martin NaughtonMr. Frank AhernMr. John MillsMr. David BrabazonMs. Patricia CotterMr. Laurence Joseph TobinDr. Niall PenderMs. Stephanie Miller Mr. Omar Hassanein

Company Secretary:Fiona Murphy

Solicitors:Sheridan Quinn Solicitors29 Upper Mount StreetDublin 2

Bankers:Allied Irish BankGeorges StreetDun LaoghaireCo. Dublin

AuditorsGrant ThorntonChartered Accountants & Registered Auditors24-26 City QuayDublin 2

Registered in Ireland No:198247

Charity No:CHY 7417

Registered PremisesBlackhall Green, Off Blackhall Place, Dublin 7www.headway.ieTel: 01 604 0800Fax: 01 604 1700Web: www.headway.ie

Keith BarryAmbassador

Glen PowerAmbassador

Brain Injury Services & Support