Fidelma Healy Eames (Fine Gael)
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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.

Phil Hogan (Carlow-Kilkenny, Fine Gael)
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I am taking this matter on behalf of my colleague, the Minister for Children and Youth Affairs, Deputy Frances Fitzgerald. I am pleased to have the opportunity to update the Seanad on work relating to the new child and family support agency.

In the programme for Government we made a commitment to fundamentally reform the delivery of child protection services by removing responsibility for child welfare and protection from the HSE and creating a dedicated child welfare and protection agency, reforming a model of service delivery and improving accountability to the Dáil. Accordingly, the Minister, Deputy Fitzgerald, established a task force on the child and family support agency in September 2011 under the chairmanship of Ms Maureen Lynott. The task force will advise the Department in regard to the necessary transition programme to establish a child and family support agency and will base its work on best practice in child welfare, family support and public administration, consistent with the Government's public sector reform agenda.

In regard to the agency, it has been asked to propose a vision and principles to guide operations; advise on the appropriate service responsibilities and the delivery of same; review existing financial staffing and corporate resources and propose a methodology for resource allocation; propose an organisational design and operating child welfare and protection service model; prepare a detailed implementation plan; identify the main priorities and co-relationships required; and oversee the implementation and monitor progress, pending establishment of the agency. As I have already outlined, the task force will advise on the appropriate service responsibilities for the agency during the course of its work from among those within the HSE that relate to children and family services or from within the relevant operational responsibilities of the Department of Children and Youth Affairs or its agencies.

In addition, the Senator will be aware of last week's Government statement on the public service reform plan. It confirmed that the family support agency will merge into the child and family support agency by 2013. The Government also stated that the role of the National Education Welfare Board will be reviewed by June 2012 in the context of the establishment of this new agency. No other decisions have been made in regard to other services for the new agency, either universal or targeted for children and families, including public health nursing services. It is clear that public health nurses have an important role to play in a range of child and family services.

I understand that a new public health strategy is currently being developed and it is the intention that the Department of Children and Youth Affairs will liaise with the Department of Health and the HSE with regard to any new developments in the context of the establishment of the new agency. A review of public health nursing is under way in the HSE, which includes community nursing in the context of the role to meet primary health care services, which will include children services. It is anticipated that a summary report will be finalised in January 2012 and it will specifically consider the role public health nurses can plan in supporting children's health care in the community.

The Minister, Deputy Fitzgerald, looks forward to receiving the report of the work of the task force, which will inform preparations for the new agency, including the drafting of legislation. It is her intention, working with her colleague the Minister for Health, to establish a dedicated child and family programme within the HSE in 2012. This will provide for a dedicated management structure and a budget for children and family services. Management of these services will be led by the national director, Mr. Gordon Jeyes, who already has a very close working relationship with the Minister, Deputy Fitzgerald, and her Department. A considerable change programme has already been implemented by the HSE's national director of child and family services, aimed at strengthening organisational capacity, business processes and systems. These developments are an integral part of preparations for the new stand-alone agency.

The Minister, Deputy Fitzgerald, is anxious to advance the full establishment of the agency at an early date subject to the work of the task force and the necessary legislative provision. It is envisaged that legislation will be tabled before the House next year to provide for the agency's establishment in 2013.

Fidelma Healy Eames (Fine Gael)
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The Minister probably does not know the answer to the question I am about to ask and it is not fair to expect him to be able to answer it. Will he ask the Minister for Children and Youth Affairs if public health nurses will be included at a decision making level as opposed to only submissions being taken because they are a key stakeholder in child and family health? That is the key question.

Phil Hogan (Carlow-Kilkenny, Fine Gael)
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As I said, it is a matter for the Senator to be able to bring this matter to the attention of the Minister, Deputy Fitzgerald. I will convey the Senator's view to the Minister and the Senator may be able to engage with her directly on this matter. I am not in a position to give that information to the Senator.

Fidelma Healy Eames (Fine Gael)
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I appreciate that.