Paul Gogarty (Dublin Mid West, Independent)
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Here is a quote for the Minister of State:

Every child gets free health and development checks from 0 to 5 years. This is to make sure they are healthy and developing normally.

Checks will happen with a healthcare professional, for example your public health nurse (PHN), GP practice nurse or GP. They will normally happen at home or at your local health centre.

You can use these visits and health checks to ask any questions or talk about any concerns about yourself or your baby.

This is not misinformation on a Facebook post generated by some IT farm in Russia. This is not a typical post on X. This is not even a statement from the White House briefing room. This is our own Health Service Executive, but it is factually misleading, because in the constituency I represent, Dublin Mid-West, within community healthcare organisation, CHO, 7, in areas like Lucan, parts of Clondalkin, Newcastle and elsewhere, parents have been unable to get health checks. Stephen Donnelly, the former Minister, confirmed that GPs do not do the checks. Parents have tried to have them carried out. The Government has acknowledged many times before that this is a problem. The main responsibility for carrying out the checks rests in the hands of our hard-working, hard-pressed and underpaid public health nurses. As we know, along with staffing in other areas of healthcare, there is a serious shortage of public health nurses across the country. This is especially true in my constituency. Despite advertisements at job fairs abroad, we have not been able to get nurses.

I have been raising this matter for several years. If we cannot get these healthcare professionals in, we have to look at new ways of doing it. That is why I believe that a Dublin allowance would make a great deal of sense. There is a precedent in this regard. There is such an allowance for inner London and outer London. There is something similar in Paris. This is an important matter, particularly as 14,000 of the 80,000 nursing staff in the country in 2010 have left. We need to bring those people back.

Naoise Ó Muirí (Dublin Bay North, Fine Gael)
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I thank the Ceann Comhairle for selecting this matter for discussion. I remember these development checks being carried out in respect of my children not so long ago. They are vital for good early childhood development. The checks include, as Deputy Gogarty mentioned, visits to the clinic and public health nurses coming to people's homes. They make sure that children are healthy and developing normally. If the checks reveal issues, it is really the first time for making early interventions and bringing in other services and other professionals to support a child's development. I always found that public health nurses were really good at their job. They are experienced, are grounded, build good rapport with children and parents and set people's minds at ease.

It is concerning to hear from constituents that checks are not being done locally. A family in Killester contacted me. They were sent to Millmount in Drumcondra for their first check and then were told that neither Millmount nor Killester could send a nurse to them for the second check. A local development company in Coolock had a similar experience. It is getting feedback in Coolock and nearby areas that the checks are not happening. Those areas are marked by economic and social disadvantage. The last thing we need is to load issues relating to health checks and developmental issues onto the backs of hard-pressed families who live in the areas in question.

I congratulate the Minister of State on her new post. It is vital that the HSE gets recruitment done as soon as possible in order to rebuild these teams. There is a need to have new nurses recruited and appointed in order that checks can start again. This is a really important front-line community service for young folks in particular. I urge the Minister of State and the Department to work with the HSE. I also urge that what we are discussing should become a priority for Government.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I thank both Deputies for raising this issue. I am from Cavan-Monaghan and do not live in the Dublin area, but I have heard much discussion in the media in recent days about the concerns of parents, particularly parents who are expecting their first child and who do not have access to a public health nurse to make those all-important milestone checks.

The Government remains committed to providing continued investment in the health workforce, including public health nurses, and ensuring that this service is available to those who need it. Public health nurses are employed by the HSE to deliver safe, quality and person-centred community nursing care across people's lives. There are currently 1,511 whole-time equivalent, WTE, public health nurses employed in the HSE. A further 27 posts were provided for in budget 2025. The Department of Health has requested that the HSE expedite recruitment to these posts in areas where child health developmental assessments have been impacted.

It is important to note that the HSE recruitment pause ended in July 2024. There is currently no impediment to normal recruitment or replacement of staff within agreed WTE limits. Each regional executive officer will continue to prioritise, recruit and replace staff within the approved numbers as appropriate, including public health nurses. There are known challenges with the recruitment and retention of public health nurses, and right across the health sector, particularly in parts of Dublin. The HSE has established a national oversight group with specific focus on community nursing services to address these issues. Several short-term, temporary solutions to prioritise resources and service provision in line with clinical needs have already been undertaken in areas most affected by high vacancy rates.

Some areas are operating a priority 1 service as per the HSE's national caseload prioritisation procedure. They are, therefore, prioritising essential care, including birth notification visits and post-natal assessments. As of last month, ten local health offices were using the national caseload prioritisation framework to provide services. These include the office in Lucan, which falls within the remit of HSE Dublin and Midlands, of which the former CHO 7, to which Deputy Gogarty referred, is part.

Where the prioritisation framework is used, child health developmental assessments have, in some instances, not been provided. I acknowledge the concerns of parents where access to these important public health nursing services is limited. The Department of Health is working with the HSE to address these challenges as a priority in the programme for Government. I take on board the suggestions made about how we can entice people into those all important positions as public health nurses.

In 2024, to attract more nurses to specialise as public health nurses, it was provided that existing nurses who wish to enter the public health nurse sponsorship programme could remain on their current salary scale. Public health nurses have seen their salary scale improve with the addition of one further scale point and the introduction of a long service increment. This measure has contributed to an increase in the number of applicants to the programme in 2024 and 2025. In addition, over the lifetime of the current public service agreement, public health sector staff, including public health nurses, will receive a pay rise of 9.25%. They are some of the introductions being made to try to address the issue, but I know, as has been raised tonight, if parents are living in the area and have a newborn baby or are expecting one, they need solutions right now. I take on board the suggestions made and the concerns raised.

Paul Gogarty (Dublin Mid West, Independent)
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These checks are crucial for the early identification of any developmental concerns, allowing for timely interventions. and they can significantly enhance or basically curse a child's prospects in the future if it is not looked at. Parents are understandably concerned about the need to have their children assessed in a timely manner, and it cannot be done privately. Maybe that needs to be examined in the context of something like the treatment purchase fund while we are trying to sort it out.

In the limited time I will mention the cross-cover arrangements in place for priority cases. It is not fair, taking the country as a whole, that one area can be well staffed and then areas such as in my constituency are not as well staffed and the load is not being spread out. That needs to be examined, but there was little mention of a Dublin allowance in the response. I would like to see it looked at because it is best practice in other countries, and as well as pay increases, we need to entice people in high-cost environments to come to work here.

Naoise Ó Muirí (Dublin Bay North, Fine Gael)
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I thank the Minister of State for her response. I agree with Deputy Gogarty that something needs to be done around Dublin. The numbers are pretty stark. The health service capacity review of 2018 envisaged a big increase in the service by 2021. Baseline capacity was meant to be 2,000 public health nurses nationally by 2026. We are at just over 1,500, which is almost 500 short in terms of where the service is meant to be by now. I acknowledge there are challenges in recruitment and in keeping public health nurses, but it is a serious issue now and has to be dealt with straight away, whether through the NTPF or some other mechanism. I again urge the Minister of State that we try to prioritise it and get some capacity back into the Dublin region. These parents are worried about it, and it is a concern for them, as she will understand, that they get access to a service and to those checks again.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I thank both gentlemen again for raising this important topic. The Government remains committed to providing continued investment in the health workforce, including public health nurses. I take on board the suggestions relating to capacity, recruitment and the Dublin allowance. There is also that piece about how we maybe have lots of staff who are willing to be in the HSE and public health and there are areas like Dublin, including the Deputies' constituencies, where they are thinner on the ground.

The 27 WTE posts were provided for in budget 2025 and the Department of Health has requested that the HSE expedite these posts to areas where child health developmental assessments are impacted. Several short-term, temporary solutions to prioritise resources and services provision in line with clinical needs have been undertaken in areas most affected by the high vacancy rates. In 2024, to attract more nurses to specialise as public health nurses, it was provided that existing staff nurses who wish to enter the public health nurse sponsorship programme could remain on the existing point of their current salary. As of November 2024, 86.6% of all three- to nine-month child development assessments were completed in time and before them reaching their 12-month old milestone. I acknowledge the concerns raised tonight and that the Deputies are raising them on behalf of their constituents. I acknowledge the suggestions they have both brought to the table with regard to how to address it.