Ms Mary O'Dowd:

I introduce Ms Brigid Catterson, the chairperson of the institute's children and family interest group. The title of our presentation is, Best Health for Children in 2013. I thank the committee for this opportunity. We wish to raise some critical issues regarding child health services in the community. The Institute of Community Health Nursing, ICHN, is a professional organisation established in 1985 for public health nurses and community registered general nurses, RGNs. In light of the planned child and family support agency Bill, the ICHN wishes to discuss with the committee the role of the public health nurse, PHN, in child health and well-being and that it is essential in the best interests of children that a dedicated, health-promoting, preventive nursing service for children and families be developed as a matter of urgency. A PHN child health service is not included in phase 1 of the new agency.

Census 2011 identified the number of pre-school children aged 0-4 at 356,000, an overall increase of 17.9% since 2006, and the population of the primary school age group at 504,000, an increase of 12% since 2006. The PHN has an opportunity to assess all these children and families. The dual role of the PHN in clinical care and public-population health and well-being is prioritised towards clinical nursing care as a result of Government policy, the primary care and implementation processes, the moratorium on the recruitment of nursing staff and the absence of a national workforce plan for primary and public health nursing in the future.

The ICHN has been advocating for a number of years to convince policy makers of the gaps and challenges that exist in implementing Best Health for Children, which was first published in 1999 and revisited in 2005. This programme sets out a clear, evidence-based health programme for pre-school and primary school children. The recommended 0-4 years contact by the PHN with the children and family commences with a visit approximately 48 hours after discharge from the maternity hospital and four subsequent pre-school visits. We are the only health professional group who visit the home of every newborn child and mother in Ireland. This places us in a unique position to build relationships with families and their communities.

Performance indicators on early years health screening is limited to quantitative data in the first year. There are no national data performance indicators measuring outputs and outcomes at the 18-24 month screening and the 3.25 to 3.5 year screen. The HSE health staff performance report of 2012 reported a variation of 38% to 100% of children reaching ten months who had received their 7-9 month screening on time, demonstrating an inequity of service delivery to this population group across the country. A recent review by the institute of the school health service demonstrated that the recommendations from Best Health for Children on school health screening are not uniformly implemented. This has resulted in variance in the timing, programme content, equipment and referral criteria and pathways across the country. There are no national key performance indicators on the delivery of school health nursing service.

The ICHN strongly advocates for the provision of designated school health teams for the school health and well being surveillance programme and promotion. The Monageer inquiry 2009, which considered child abuse and protection, recognised that the public health nursing service provided to pre-school children was critical to the identification of children in families in need of early intervention. The institute strongly advocates for improved systems for the further professional development of PHNs to address this need. The child and family needs assessment framework is an assessment tool developed by public health nursing in the midlands. It facilitates early identification of vulnerable children and families, mobilises appropriate early identification and prevents the need for child care and social work services except in cases of serious concern and risk of harm to children. Evidence shows it is possible to prevent abuse and neglect with effective systems and interventions.

The parent-held record is a record held by the parent, which allows it so be shared with other health professionals working with children and their families. The parent-held record is in use in only eight former LHO areas of the country.

The electronic information obtained from this child record has the potential to report the outputs and outcomes relating to child health and well-being. Every child has a right to be afforded a high-quality, equitable community health nursing service. Many children in the community require specialised care and have difficulty accessing services. Despite the variations highlighted in the previous reports, many inequalities remain in the quality of this service. In light of the new child and family agency, the institute believes that the child health service warrants a dedicated focus to improve the systems and delivery of health care to all children in the community. We believe the public health nurse is ideally placed to identify and support families and to counter the obstacles that mean not every child reaches his or her full potential.

The current model of community nursing established in 1966 is not addressing the recommended child health programme. We seek the committee's support in promoting a dedicated child health workforce with proper resources and education that can deliver this service on time to all children with systems that can measure outcomes of child health and well-being. We ask the committee to make a formal proposal to the Minister for Health and the Minister for Children and Youth Affairs.