Mr. John Hennessy:

I thank the Chairman for the invitation to attend the committee to discuss the issue of public health nursing. I am regional director for HSE West. I am accompanied by Dr. Michael Shannon, director of nursing and midwifery services in the HSE, and Ms Martina Queally, area manager for HSE Dublin South East.

The delivery of community nursing services that effectively meet the health needs of the population within a primary care setting is the primary aim of the public health nursing service. The continued development of primary care teams is also being progressed, focusing on increased emphasis on care in the community and integration of services as outlined in the HSE 2013 national service plan. Multidisciplinary primary care teams provide health and personal social services as well as being the first point of contact for patients and clients in a local setting, which and ensures continuation and co-ordination of services. In the context of care and reform and the current drive toward an integrated health system, treating and delivering care to patients in more appropriate settings is an integral part of the role of the public health nurse and the registered general nurse working in the primary care teams. Public health nursing in Ireland is continuing to evolve in response to the growing demand for health care services in the community, as mentioned by Ms O'Dowd in her presentation.

The public health nursing service provides an extensive range of services within the Irish health service - for example, it provides children’s health services, including post-natal visits and developmental screening up to six years of age. The role of the public health nurse in safeguarding and protecting the health and well-being of children is also provided for in legislation, in the Child Care Act 1991 and the Children First guidelines 2011.

Immunisation programmes are provided as part of the school health service. The school health screening programme, as outlined in Best Health for Children, and immunisation programmes are currently available to schoolchildren in accordance with the national immunisation guidelines of 2008. Public health nurses are involved in the assessment of need and the provision of services to children and adults with disabilities. Health policy also endorses maintaining older adults in their own environment and in their own homes, where possible. Older persons receive assessments and are provided with services including home care packages in accordance with need. The public health nursing service is extensively involved in palliative care and the support of terminally ill patients in community settings. Patients with long-term illnesses are supported in the home setting. Patients with hepatitis C receive services, including the support of the public health nursing service, in accordance with assessed need.

Most important, public health nurses are often a key conduit for the dissemination of information and advice on health to all sectors of the population, often as the first point of contact. In conjunction with its core services the public health nursing service has expanded its remit to include the following: the development and expansion of community intervention teams whose primary aim is the avoidance of unnecessary hospital admission and the facilitation of early discharge from hospitals; the development of the school immunisation programme to include the education of public health nurses to oversee immunisation under medication protocol; and the schools vaccination programme, which is currently being delivered by immunisation teams including area medical officers and public health nurses in many areas of the country. It is anticipated that this programme will be nurse-led in the future. Support is also provided for clinical care programmes which help to facilitate the timely discharge of patients from hospitals. The aim is to allow patients to receive more rehabilitation at home, to remain at home in the long term and to regain independence in daily activities. Support for the nationalnewborn blood spot screening service is another function of public health nurses, who are responsible for ensuring that the test is carried out following notification and that all babies residing in their areas have been offered screening. Public health nurses are involved in the expansion of clinic-based services where appropriate, including assessment and treatment of wound care, continence care, child health, adult health checks, diabetes clinics and parenting programmes. The delivery of more complex care to patients in the community undergoing oncology treatment is also a developing area, and this is currently in place in a number of areas in the west of Ireland, including Donegal and Galway.

There are currently 3,312 public health nurses on the register with An Bord Altranais, of whom 2,402 are on the active file. In March 2013 the total number of nursing staff employed in the public health nursing service was 2,067 whole-time equivalents, broken down as follows: 15 directors of public health nursing; 122 assistant directors of public health nursing; 1,512 public health nurses; 418 registered general nurses; and 43 student public health nurses. Since 2006, in order to streamline the sponsorship of student public health nurse training, the HSE and four participating training colleges, UCC, UCD, NUIG and St. Angela’s College, have undertaken a process of joint entry and recruitment. For the past number of years the four regional directors in the HSE regions were requested to identify their annual sponsorship requirements based on service need. Sponsoring local health office areas provide clinical placements to public health nursing students while they undertake the full-time higher postgraduate diploma in public health nursing. This year, a total of 85 student public health nurse sponsorship places have been allocated, with 14 in the west region, 14 in the south region, 27 in Dublin north east and 30 in the Dublin mid-Leinster region.

In 2013, primary care development funding of €20 million will be invested to support the recruitment of prioritised front-line primary care team posts and to enhance the capacity of the primary care sector. The 2013 national service plan has prioritised the appointment of approximately 250 primary care posts, including public health nurses, registered general nurses, occupational therapists, physiotherapists and speech and language therapists. The recruitment and appointment of people to fill these posts is currently under way.

Analysis has revealed considerable variation across the 17 integrated service areas in the ratios of health care professionals to population and to population numbers in areas of high deprivation.

Based on this analysis, the 70 public health nurses and 37 new registered general nurses in the programme of development for this year will be recruited and deployed to primary care teams under this year's plan. Approximately 42% of the new development posts envisaged in this year's plan will be new nursing posts.

A review of public health nursing services was commissioned by my colleague, Dr. Michael Shannon, director of the office for nursing and midwifery, in 2011, with the assistance of the public health nursing service and the Institute of Community Health Nursing. An expert group was chaired by Dr. Joe Clarke, primary care clinical lead, and the review was completed and published in March 2012. It has helped to inform future policy on the integration of services and the delivery of efficient and safe care to clients in the community.

I will refer briefly to the education programme for public health nurses. The programme educates students to be able to practise as confident, accountable and autonomous public health nurses, with the ability to work in partnership with other members of the primary care team and committee based organisations and with the aim of maximising their contribution to health improvement. Student public health nurses are educated within a national and international context on the principles of professional issues of health promotion and health promotional aspects of public health nursing. The programme has regard to the needs of younger people, families, patients with chronic illnesses, people with disabilities and adults and older people in the community.

In regard to children and families, in particular, I will address some of the points alluded to by Ms O'Dowd. The programme addresses the following modules: theoretical perspectives on child development pathways in early to middle childhood; public health nursing services for families and children aged up to 12 years; determinants of child and family health, including risk and protection factors which influence child health; the concept of prevention, assessment of risk and vulnerability; child health surveillance and screening; child health promotion; assessment planning; implementation and evaluation of nursing care services in consultation with an individual, family, group or community, delivered in conjunction with other primary care team members; best practice in child protection, which includes legislation and policy on child health for young people and families; developing a partnership with children, families and communities; multidisciplinary and inter-agency communication; good practice in child protection; teamwork, networking and collaboration; and interdisciplinary work in the childcare context, including case conferencing.

Public health nurses and community registered general nurses provide a competitive range of nursing and midwifery services as outlined and within the context of unprecedented change and evolving service needs as part of primary care teams. Priorities already identified for the future include developing capacity and systems within the primary care teams and across health and social care networks to deliver a more complex and broader range of care services to communities. This will include responding to the additional requirements arising from implementation of universal healthcare, an increased emphasis on health promotion and well-being for communities, increasing incidence of cancer and chronic diseases in our ageing population, for whom more care will need to be provided at or near the patient's home and requirements for a specialist nursing practice and the provision of nurse-led services for some populations, for example, those with diabetes, chronic heart failure and other chronic conditions.

Together with my colleagues, I will attempt to take the committee's questions.