Emer Higgins (Dublin Mid West, Fine Gael)
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I want to discuss the ongoing shortage of public health nurses in my area, particularly in the constituency of Dublin Mid-West. This shortage is having a huge impact on infant developmental checkups. To my count, this is the seventh time I have formally raised this issue, whether in the House or through parliamentary questions, since it was first brought to my attention last year. I have had two meetings with representatives of the HSE. I know the Minister of State will understand that I will continue to raise this issue until it is sorted. My constituents, especially those in Newcastle and Lucan, are getting extremely frustrated by this. That is understandable.

Since I first highlighted this issue, babies and toddlers have missed vital developmental checkups. Some have missed two, whether those are three month, nine to 11 month, 21 to 24 month, or 46 to 48 month checkups. I do not need to tell the Minister of State that developmental checkups are vital when it comes to picking up potential issues. Currently, babies in Lucan and Newcastle may be showing early signs of developmental delay or a health issue but it might be going unnoticed. That is a real fear for new parents in particular, who are navigating parenthood for the first time, and may not yet be as familiar with the signs to look out for.

We talk all of the time about early intervention, and how important it is to detect and treat issues as early as possible, yet the HSE is providing no intervention whatsoever for these infants and their parents in my area. It is not just about early detection of issues; it is also about giving parents, particularly mums, that peace of mind many really need in those early years. Even if there is nothing to worry about with their child's development, having someone to listen to their concerns who is trained to identify issues and reassure them that everything is okay is extremely important for parents. It is extremely important for their mental health. To know that they have these periodic checkups with their public health nurse as their baby grows and becomes a toddler is hugely reassuring. This reassurance has been taken away from parents in my constituency. That is simply not good enough. It needs to be resolved as soon as possible, especially considering that it is these parents' hard-earned taxes that are meant to provide this vital service.

I have had mothers come to me saying they are terrified to give birth without this service in place for their newborn babies, which is awful. I have been contacted by parents outraged that their new baby is not getting the same service that their older children got. That is just simply unfair. One mother told me:

We are first-time parents and we are really distressed at the thought that our baby will not receive the basic level of care that the HSE advises, just because we recently moved to Newcastle recently and there's no public health nurse situated here.

Yet, if that mother had not moved and lived somewhere else, her baby would be getting those checkups. It is like a postcode lottery. I met with HSE officials on Monday last and they were keen to stress that this is not an issue of investment. The money is there. The issue is the pipeline of nurses. I have been told again and again that as soon as student nurses come on stream, this matter will be resolved. However, time has moved on and they have not appeared in my area. That pipeline has not materialised. We all know that, once qualified, public health nurses are free to work in any area. That is understandable and right, but it means that Dublin is effectively training public health nurses to head back down the country. There has to be an incentive for them to choose to work in areas such as Lucan and Newcastle, where there is huge demand given the demographics. We have to get much-needed public health nurses into areas where there simply are none. I ask the Minister of State what the plan is to fix this.

Neale Richmond (Dublin Rathdown, Fine Gael)
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I thank the Deputy for raising this. She said this was her seventh time bringing it up. I did not quite get to seven. I think I hit five times raising the issue of public health nurses in south Dublin. This is an issue that regularly crosses our desks. Both the Deputy and I represent suburban Dublin constituencies. She certainly does not need to convince me of the importance of public health nurses or the vital role they play. I fully agree with it. However, I am taking this matter on behalf of the Minister for Health, Deputy Donnelly. While I have a detailed response here that focuses on the importance of the public health nurse, I know the Deputy will have received most of this already. I want to talk about the fact that there are clear staff shortages.

Unfortunately, at present the public health nursing section in Dublin west, which covers Lucan and Rathcoole, is one such area impacted by significant staff shortages. This represents a significant challenge for the service. In response to these staff shortages, the public health nursing service in Dublin west is prioritising services, including child development checks, to ensure the delivery of a safe service to the most in-need cases in the community. The Department of Health fully acknowledges the frustration of parents, families and the wider community in Dublin west and mid-west where these staff shortages and delays in accessing routine services are no doubt causing anxiety and stress. The Department and the HSE encourage parents who have a concern or query regarding a child's development to contact the public health nursing service directly to discuss their concerns.

The HSE has assured the Department that efforts are ongoing to recruit nursing staff. However, recruitment to vacant nursing posts continues to challenge the nursing services, despite ongoing recruitment campaigns and attendance of recruitment fairs both nationally and internationally. At present a rolling campaign is under way to fill vacant positions in Dublin. Frustratingly, to date, none of the vacancies have been filled in the Dublin west region. The Department fully acknowledges that much more needs to be done to ensure the vital services public health nurses provide are available in all parts of the country. Last year, in response to these recruitment challenges, the HSE established a community nursing oversight group tasked with the development of proposals and recommendations to address the challenges of recruitment and retention in community nursing. The Department will continue to work with and support the HSE to ensure these issues are addressed. The HSE has assured the Department that it will continue to run recruitment campaigns in Dublin west and the public health nursing service will continue to strive to provide the required nursing services to the population.

The Deputy made an interesting and valid point about potential incentivisation for those who will stay in Dublin. The matter is perhaps not only for the Department of Health but for the Department in tandem with the Department of Public Expenditure, National Development Plan Delivery and Reform. I undertake to bring it back to the relevant Ministers. The other area is international recruitment, which specifically falls under my brief in the Department of Enterprise, Trade and Employment with regard to the provision of work permits. We have a generous work permit system for critical skills, which include nursing. We are keen to ensure it is expanded and that we facilitate the continued recruitment of nurses from outside the European Union and European Economic Area to fulfil the clear need of our entire health system, and in particular the public health nursing system. I will take a moment to underline from a personal point of view the importance of getting the numbers across Dublin, especially in the Deputy's constituency of Dublin Mid-West and mine. I am dealing with many people whose cases I know are also crossing the Deputy's desk who are entering her clinic and ringing her telephone on a daily basis about this matter. They are doing the same to me and I fully empathise with her position. I undertake to do everything I can in government to push on this agenda and get those positions filled.

Emer Higgins (Dublin Mid West, Fine Gael)
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I appreciate the Minister of State's support and commitment to this issue. I hope to get some information today with which I can go back to the worried mums and dads in my area because I cannot keep giving them the same outdated information. I cannot keep telling them the HSE is doing its best to recruit more public health nurses, with no timeframe. There is no light at the end of the tunnel if I keep saying that. The Minister of State has confirmed on the record that no vacancies in the public health nursing team in my area have been filled. The allocation of student health nurses will be done in the next two weeks, in early June. I hope it changes things and that the HSE can encourage people to go into areas where vacancies have not been filled in a long time.

I appreciate that the Government cannot instantly create public health nurses where there are none. The Minister of State said that this is also an issue in his constituency. Dublin is not overflowing with public health nurses we can borrow but short-term measures have to be put in place to support parents and there has to be a long-term solution to fix this problem into the future. I do not see either a short-term or a long-term solution being offered by the HSE right now. It seems that if we do not keep shouting about this issue, it will fall by the wayside and public health nurse checkups may become a thing of the past. That would be an absolute shame for our society because supports for new parents, and new mothers in particular, are not exactly in abundance as it is. There is often an attitude that mothers should naturally and innately know what to do but we know that is not true. No one is born with an innate knowledge of what healthy child development looks like. Even nurses and midwives I have spoken to know how valuable their public health nurse was to them in the first few years of their babies' lives. Public health nurses love doing this work. They love meeting new parents and new babies, seeing them develop and being part of that journey. The bottom line is that more nurses must be incentivised to pursue public health nursing and qualified public health nurses need to be incentivised to work in the areas with the greatest need. It is great that the Minister of State pointed out that the recruitment of international nurses coming under his brief. Perhaps he can tell us a little more about that and how it can be used to solve this issue for my constituents.

Neale Richmond (Dublin Rathdown, Fine Gael)
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On behalf of the Minister for Health, I thank the Deputy. He fully acknowledges the concerns of the Deputy and the wider staff about the impacts these shortages are having. As the Deputy and I laid out, there are recruitment challenges generally across several sectors, not only the health sector, but they are in the health sector. This is posing a particular challenge for the public health nursing service at present. Some 40% of posts are vacant in the Dublin west region, which covers the Deputy's constituency. In response to these staff shortages, the public health nursing service is triaging all referrals to ensure a safe service is provided to those with the greatest clinical need in the community. This is important. While it is disappointing and frustrating that staff shortages persist, the Department has been assured by the HSE that every effort is being made to address the recruitment challenges in the short term, including by running ongoing recruitment campaigns. It is expected that the HSE's community nursing national oversight group will propose recommendations later this year that aim to address some of the longer-term issues regarding the recruitment and retention of public health nurses and community registered general nurses. The Minister wishes to reassure the Deputy that his Department and the HSE will continue to work together to review and monitor staffing and service levels and to utilise all practical options to fill vacancies in Dublin and elsewhere.

As I mentioned in my opening reply, my Department will do anything we can to assist, such as bringing nurses in from overseas. It takes 16 days to turn around a work permit at the moment. More generally, a critical skills permit for a nurse or other medical professional can be issued in under a week at the moment. We are more than happy, when the HSE is prepared to engage with nurses, especially public health nurses, from outside the EU to ensure they get here as quickly as possible.