Health promotion, the role of the media, service provision and the need for research to inform policy have been identified as the important issues in formulatinga region-wide policy on hepatitis C. These were the key findings of the report of a consultation process involving service users, service planners and a wide range of health and social care professionals launched in December 2004.

In addition, peer support, education and training, liaison between services facilitated by liaison nurses and key workers, making services more accessible and exploring the role of psychological and complementary approaches to treatment were identified as important actions to address these issues.

The report was based on the findings of a consultation event held in June 2004 and organised to assess the health and social care requirements for those with or at risk of acquiring hepatitis C.1  The method used in the consultative process was ‘open space technology’.  ‘Open space' is a qualitative methodology used to enable a large and diverse group of people to explore complicated issues in a limited time by presenting participantswith central themes.Organic and self-organising, the participants set a detailed agenda and subsequently facilitate qualitative discussion at impromptu workshops. The contents of the discussions are simultaneously documented.The central themes, presented in the invitation to this event, were: ‘What are the significant issues in formulating a region-wide policy on hepatitis C’; and ‘What are the optimum approaches to these issues?’

Over 70 people attended the event; among them were service planners, health and social care professionals and service users. With respect to the first of the central themes, the participants identified the issues they would like on the agenda on the morning of the event.

The participants identified 16 significant issues and a workshop was organised for each issue. A small group discussion took place on each topic and a workshop facilitator recorded the issues raised during the discussion. These data were subsequently analysed using qualitative methods.

Four common themes emerged from the 16 workshops:

• Health promotion:There is need to develop a set of consistent messages on modes of transmission, pathways to treatment and success of treatment, with such messages delivered through a variety of media.
• Role of the media:Another need was to ensure that the mass media provides accurate information to the general public and high-risk groups. It was suggested that the media use an approach that allays fears and reduces the stigma associated with the infection.
• Service provision: It was noted that access to and availability of services to prevent or treat hepatitis C should not be associated with mode of transmission. There is a need for equivalence of care between several groups, for example, those who acquired their infection through blood products versus injecting drug users; those who live in Dublin versus outside Dublin; and those in prison versus those in the community. The information about, criteria for and pathways to treatment should be transparent and easily accessed. Expansion of nursing and psychology services to support those testing positive for hepatitis C is required.
•  Research, policy and planning:In general, the participants emphasised the importance of an extended surveillance system to ascertain the extent of the problem but stressed that such a system must protect the identity of the individual. Participants also wanted research to develop best-practice protocols (including medical and complementary therapies) to manage this infection. 

In the afternoon session, the process was repeated to explore optimum approaches to the themes identified in the morning. Eight actions were identified and a workshop was organised to deal with each action. A number of common themes emerged from the second set of workshops:

• ·Peer support and prevention: The importance of using peer groups in planning and developing prevention, harm reduction and treatment interventions was stressed. Peer-group insight and experience was considered very useful in ensuring that new approaches would be appropriate. It was also suggested that indicators would be developed to monitor and evaluate prevention and harm reduction interventions.
• Education and training: The actions suggested were in line with the health promotion actions identified in the morning session.
• Liaison, key workers, co-ordination and collaboration: A number of suggestions were made, including appointment of key workers (such as liaison nurses); development of transparent communication policies and procedures; improvement in access to services through multi-agency collaboration; and introduction of a core monitoring group to ensure client-centred services. 
• Accessing services: Developments to make services more accessible and user-friendly were identified as a priority.
• Psychological and complementary therapies: Respondents thought that psychological support and complementary therapies, in conjunction with medication, would be very beneficial to a client’s quality of life.

The event represented an ongoing collaboration between two groups – the Hepatitis C Scientific Advisory Subgroup of the Blood Borne Virus Forum (a group of health and social care professionals with an interest in hepatitis C and related issues) and the Eastern Regional Health Authority (ERHA). At the launch of the report in December 2004, the ERHA presented its response to the findings and its plans for the future. It was indicated that a group convened to formulate a regional policy on hepatitis C intends to audit the health services available to those with hepatitis C and to actively provide information on service availability and identify models of best practice both nationally and internationally.

In Ireland there are two major groups of people infected with hepatitis C, those who were infected by receiving blood products and those infected by using drugs, with the latter group accounting for the majority of new infections. Hepatitis C is an emerging public health problem and is likely to be a considerable economic burden on the health services in the future.

1. Hepatitis C Scientific Advisory Subgroup of the Blood Borne Virus Forum and the Eastern Regional Health Authority (2004) Hepatitis C in the Eastern Regional Health Authority: results of a multi-agency consultation event. Dublin: Unpublished.