Fidelma Healy Eames (Fine Gael)

When I tabled this matter I did not know we would only be taking it now, in the early hours of the morning. Given that public health nurses provide a universal service to all our children, will the Minister for Children and Youth Affairs outline the role they will play in the context of the new child and family support agency? The latter is extremely important and was only recently established. What steps will be taken to ensure that the service provided by public health nurses will be integrated with that of the new agency in order that children and families might have access to a seamless overall service?

Public health nurses provide a universal programme of child care for those from birth to 12 years. They are a unique group of individuals and they knock on 10,000 doors each day. The Institute of Community Health Nursing, ICHN, a professional and educational body which represents public health nurses and community registered general nurses working in primary care throughout the country, advocates for greater participation and improved systems for public health nursing that would be effective in supporting identified at-risk families. At this juncture I must declare an interest because I am a newly-appointed patron of the public health nurses. From that point of view, I wish to represent their interests and ensure that they will be included at the decision-making levels in the new child and family support agency.

The role of public health nurses encompasses primary, secondary and tertiary care from birth until death. Although public health nursing emphasises a lifespan approach, in practice time involved in direct and indirect work is predominantly spent on older people and with child health groups. Effective public health nursing requires an ability to work in partnership with individuals, families and communities in their own environment and in a way which has due regard to the determinants of health. The HSE office of nursing and midwifery is currently reviewing the public health nursing service. It is good that the debate relating to child and family services is running alongside this review. At all times the welfare of the child is paramount and public health nurses, as part of the primary care teams, have been identified as "prime workers" with children at risk in the community. Public health nurses visit every family with a new infant and then return on a number of occasions during the course of the child"s life. Public health nurses' knowledge of local communities is critical to identifying supports and resources for families. For example, their specialist education and training enable them to identify when families require referral to the social work services. As a prominent referrer to child protective services under the Child Care Act 1991 and the policy guidelines issued by the then Office of the Minister for Children and Youth Affairs in 2010, a public health nurse will work with families by using an ecological approach to identifying need, risk factors and issues of concern in order to prevent a child from crossing the threshold of significant harm.

The great thing about public health nurses is that they act as a kind of early warning system. There are approximately 1,700 of these nurses throughout the country. As already stated, they knock on 10,000 doors each day and their knowledge must be fed into the system at the critical stage. If the latter is not done, then these nurses will be nothing other than a wasted resource. What I have learned about public health nurses in recent weeks has led me to conclude that they are an undervalued and under-used resource. Where child abuse concerns arise, public health nurses work with multidisciplinary teams in supporting and monitoring the families involved. In the context of safeguarding children one of the key activities that can be provided by a public health nurse is a universal health visiting service, with more intensive support for those in need to ensure all children have the opportunity to fulfil their potential.

The ICHN recommends that the Department of Children and Youth Affairs task force on the new child and family support agency should consider how to capture, develop and integrate the work of public health nurses into the agency. It has set out four ways in which this could happen. These are that the public health nurse service would remain in the HSE, configured in the same way - that is, that each area in the country would be assigned a public health nurse who, in general, would have responsibility for the organisation of all nursing services within said area; that the service would, along with other services, be transferred to the child and family support agency, thereby positioning a universal service within the agency and ensuring a continuum of services and meaning that public health nurses would be the first line of service for all families as all new births are notified to them; that one public health nurse could be appointed to each county and that person would be responsible for ensuring that child protection services involving public health nurses operate according to best practice; or that the child protection aspect of public health nurses' work would be integrated into social work teams. The latter would require the appointment of somewhere in the region of 100 to 150 additional public health nurses and would be dependent on how the social work teams are organised.

Public health nurses do not believe themselves to be adequately valued at key decision-making levels. Given that they are at the front line, they visit 10,000 families a day and they have such a key role in identifying families at risk, it seems a huge waste of a good human resource, human capital, not to use their professional experience and knowledge adequately.

The UN Convention on the Rights of the Child enshrines our collective commitment to ensuring that all children, including the most vulnerable, are properly cared for and protected from harm. While moral and social justice arguments are prominent in the rationale for focusing on prevention and early intervention, there is also compelling economic evidence for same. Evidence shows that it is possible to prevent abuse and neglect.

The Institute of Community Health Nursing believes that the public health nurse is a major stakeholder in the debate on the future direction of child and family services in Ireland and it urges the task force to fully engage with the public health nurse service in planning future services. My question is how does the Minister for Children and Youth Affairs plan to include public health nurses in the decision making layer of the new child and family agency and will she consider their inclusion in the task force? I thank the Minister for taking this matter.