Keith Swanick (Fianna Fail) | Oireachtas source

I thank the Minister for attending the House today to address my concerns regarding the Institute of Community Health Nursing. One thing we can be sure of is that all of us wish to be healthy, live long and have a family with few medical concerns but at one stage or another everyone here will use our health service, in some cases in an emergency and in others for longer term care. Therefore, we must develop, protect and care for our health services, something at which we are failing miserably. Despite the economies that have been forced upon us, we can be proud of the nurses and doctors who serve us so well. Their loyalty to us and their care should be mirrored by ours for them. The foundation of effective and economic care lies outside the walls of the high-tech hospitals and in the communities. Countless international studies from bodies such as the World Health Organization show that the highest quality and most equitable systems are based on the primary health care model, that is, the care we receive where we live.

My bias is not based on my profession as a GP in rural Ireland but on fact. Family doctors and public health and community nurses have a pivotal role to play. Every day they are serving young mothers and their babies - our future citizens - and caring for the elderly who cannot be as independent as they once were. They are a resource of which we can be proud and which we should nurture because they are our eyes in those communities. For years have been involved in the early detection of vulnerability and in identifying problems such as neglect, child and elder abuse, post-natal depression and the risk of suicide. Community health nurses are generalists. The community is their client and their caseloads include people of every age group across the whole health-illness spectrum, including mothers and babies, schoolchildren and older people as well as those with intellectual, mental and physical disabilities. They also provide care and support for those in need of palliative care as well as their families. They work from local health centres or primary care centres and provide a range of services free of charge to people, including child health visits and school visits, visits and care for older people and care on discharge from hospital. They provide home and clinical care to adults who have a nursing need and hold a medical card. They co-ordinate respite support for carers and assess the need for special equipment. These people knock on 10,000 doors every day, delivering services discreetly and effectively in a timely fashion.

These people are supported by the Institute of Community Health Nursing, a small yet vibrant body whose funding is far from adequate. In fact, it is abysmal. The organisation seeks the development of the profession in order to research what is done so it may be done better and to be an advocate for those who often cannot make their own voices heard. The ICHN is severely struggling to keep services running with the limited number of public health nurses available.We are all aware our population is ageing, and the Government and HSE are using this as justification and reasoning when explaining our crippled accident and emergency department crisis. The chronic ailments afflicting these people can and should be addressed by public health nurses in the comfort of their own homes, which afford them security and dignity. The waiting lists for older people to receive day-care services and for families to receive respite care when they need a break is a continual frustration and a bottleneck in the system.

The key word, and indeed a solution, is integration in our health system, with social services, hospitals, general practitioners and public health and community nurses working together, preferably through partnership arrangements, for the betterment of the health of our country. The problems we see in secondary care will never be rectified until primary and community care is adequately resourced.