Dr. Michael Shannon:

A question was asked about the future policy and vision for public health nursing, which is absolutely critical in the context of what Mr. Hennessy quite rightly said about the consistent and uniform delivery of public health nursing right across the country. Since I qualified as a nurse in 1985, a great deal has changed with regard to the role of nursing, the education of nurses, how nursing fits into health care governance structures and how nursing supports the broader disciplines. When I took up my current position two years ago, we compiled a report on the current public health nursing services - it was in our brief to do so - in partnership with key members of the public health nursing community, including our colleagues at the Institute of Community Health Nursing. The report, which was published in 2012, outlines the current roles and governance structures within the national public health nursing teams. Since then, I have been working closely with all the directors of public health nursing in Ireland. We have been working on the development of a position paper to clarify the roles and functions of those who support primary health care teams and, critically, support patient care in the community. There has been a discussion in that context on the role of a universal health care public health system, a specialised public health nursing system such as the child health care system, or other best practice international models. When the paper is presented to me at the end of the month, we will talk to Mr. Hennessy and our colleagues about models and options for best practice in public health nursing.

I would like to mention that what has evolved over public health nursing services over the years is that we have very competent and well-educated professionals. These are supported now by registered general nurses, a new evolution in this country over the past number of years in the context of skill mix. We must also ensure that we look at a national educational model for registered general nurses and the public health nurses for the future. We will bring proposals on that to Mr. Hennessy and his colleagues in early July in the context of suggestions on best practice for the future role of public health nurses.

Members also mentioned the issue of diabetes. In the context of nursing and the diabetes clinical care programme, we are very fortunate that we have employed quite a number of clinical nurse specialists in diabetes over the past year to support patients, both within the community and acute services. We have a shared care model that is evolutionary and follows the patient from hospital to community or community to hospital. The linchpin or critical point is that we now have a clinical nurse specialist in diabetes working with our public health nurses, acute hospital nurses, practice nurses and with the wider teams, such as GPs, primary health care workers, etc. I am very confident that the shared care practice for nursing and diabetes has developed significantly over the past year.