Evanne Ní Chuilinn (Fine Gael)

I thank the Cathaoirleach for selecting this Commencement matter and making time for it in the schedule after last week's mishap. I thank the Minister for making time this morning. I know she is very busy as we approach the recess. I appreciate her coming to the House today to discuss an escalating crisis in early life healthcare. Our HSE public health nurses do important work. I want to acknowledge that from the beginning. A worrying trend is developing, however, in some parts of the country whereby babies, toddlers and children are not receiving critical developmental checks. To explain the importance of the checks, I will quote from the HSE website:

How your child develops up to the age of 5 sets the groundwork for learning, health and behaviour throughout their life. All children [as we know] develop at different rates. Some will be slower than others but then catch up over time. Others may have an underlying problem ... Every child gets free health and development checks from 0 to 5 years. This is to make sure they are healthy and developing normally ... All checks are free of charge and provided by the HSE ... In their first six months, your baby will have health and developmental checks immediately after birth, during their first week at home with you, at 2 to 6 weeks [old] and at regular intervals up to 6 months ... At 6 to 12 months, your PHN will check your baby's physical, social and behavioural development ... At the 21 to 24 month developmental check ... your public health nurse (PHN) will talk to you about your child's development and any concerns you may have ... At the 21 to 24 month developmental ... [they] will also check your child's general health. This includes: dental health, general physical [health] and growth ... Your child will get two more checks between the ages of 3 and 5 ... At 46 to 48 months ... eyesight .... posture and large movements .... fine movements ... speech development ... cognitive development ... social, emotional, behavioural and play development ... [Finally, at age four or five] ... a public health nurse will check your child's [learning and eyesight] ...

That is just to give an idea of how much great work these public health nurses do in the best-case scenario.

A conservative estimate of the number of checks from newborn to age five, based on the HSE's advice, is eight checks by a trained professional to ensure our children are healthy and developing normally. I have a three-year-old who was seen at two weeks old and once at 24 months old when I raised a concern about his speech; that is it. Since then, parents in my locality and I have been sent official HSE letters to say our children cannot receive checks for the foreseeable future. I raised this issue in the Seanad in March and April and I have been contacted by parents in the Dublin 12 area. I have since come to learn that developmental checks are routinely postponed or cancelled in various parts of the country. It is a Dublin problem but it is also in other pockets of the country.

In one case in Dublin 12, a parent of a two-year-old was told there were too many older people in the community and that they had to be prioritised. In another case, the mother of a preschool four-year-old was told their final sign-off before attending primary school would not happen due to the HSE-Government restrictions and staffing challenges. The backlog of missed appointments was said to be a consequence of the Covid-19 pandemic.

The HSE is sending letters to the families of babies, toddlers and preschool children asking them to perform developmental checks themselves. This is deeply concerning. No parent could or should feel qualified to check the dental health of their toddler. No parent, especially a new parent, knows the difference between speech delay and selective mutism. We know the importance of early intervention in autism, ADHD and other conditions. No parent is trained to identify the early signs of a behavioural struggle in their three-year-old.

Public health nurses have also contacted me since I raised this issue. There are not enough public health nurses. I know the Minister knows that. It appears in Dublin in particular that there has been a dramatic decrease in staffing numbers due to transfer requests out of the area. This means children born in the greater Dublin area are at a geographical disadvantage in relation to early life care and development. I have also been contacted by early childhood educators who are now enrolling children in their education settings who have never been seen or assessed by a public health nurse of professional. Granted, most of the parents and healthcare professionals I have spoken to are in Dublin. I would like to know how widespread the crisis is. I would also like to know what is being done to tackle the staffing shortages in the HSE. Most importantly, I and other parents in Dublin 12 need to know how soon we can expect the full complement of key developmental checks to be reinstated for our children.