Michael Mullins (Fine Gael)
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I welcome the Minister of State, Deputy Róisín Shortall.

Trevor Ó Clochartaigh (Sinn Fein)
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Cuirim céad fáilte roimh an Aire agus gabhaim buíochas leis as teacht isteach le díriú ar an gceist seo. Ceist bheag í i gcomhthéacs na tíre í ach ceist mhór í i gcomhthéacs an phobail as a dtagaim.

I raise the issue of the public health nursing service in Connemara in light of the fact that we have heard that the public health nurse based in Roundstone who is due to retire will not be replaced. Roundstone is a very remote rural community and the public health nursing service is extremely important in that area. Other health services in the area are being curtailed, particularly dental services, due to staffing issues. We have also heard of the curtailment of services in terms of old people's homes in the area through the amalgamation of services, which is also due to staffing issues.

There is great concern, particularly in the Roundstone area, about how the service that was delivered by the public health nurse over the years will be continued, where the burden will fall and if it were to fall on public health nurses in areas nearby, would that have a detrimental effect on how they serve their existing communities? All the public health nurses working in that area are extremely busy and their jobs involve a good deal of travelling to see their patients.

In the matter I tabled I asked if the Minister could indicate the wider geographic area of Connemara and the Aran Islands which would be serviced by public health nurses. Can we expect similar situations to arise there? Are more curtailments and cutbacks envisaged in the number of health nurses there and in the provision of the services, or are the services to be rejigged? This issue must be viewed in the context of the number of people who applied for redundancy in the recent opening available to them under the public service agreement, whereby they could apply to leave the service. I understand some 3,500, people in the health services have applied to leave under that programme and there is the issue of whether that will impinge on position. Cuirim fáilte roimh tuairimí an Aire go mbeidh sé in ann léiriú a thabhairt dúinn agus deimhniú a thabhairt do phobal Chonamara agus phobal Chloch na Róin agus pobal Oileáin Árainn go mbeidh na seirbhísí in ann leanacht ar aghaidh agus go mbeidh seirbhís mar is ceart á chur ar fáil.

Róisín Shortall (Dublin North West, Labour)
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I thank the Senator for raising this issue and it presents an opportunity for me to make a number of comments on the future of the public health nursing service, particularly the service in Roundstone, County Galway, and in the wider area of Connemara and the Aran Islands.

The public health nursing service is a structure within the HSE, which consists of a director of public health nursing, assistant directors of public health nursing, public health nurses and registered general nurses and midwives. A small percentage of specialist posts are filled by clinical nurse specialists and advanced nurse practitioners. Registered general nurses work alongside the public health nurse in the community and assist with clinical nursing and caseload management. This involves the delivery of nursing care to various patient groups, including children and families, palliative care, the young chronic sick, those with disabilities and older people in the community. Care of children and families includes a universal child health screening and surveillance programme for children up to the age of three and a half years.

The changing demographic profile of Ireland, a rapidly growing older population, increases in the birth rate, increases in the number of people suffering with chronic conditions, reductions in length of hospital stay, technological advances in care delivery and increased demand for health promotional activities have impacted on the organisation, management and cost of the delivery of the public health nursing service.

The delivery of a sustainable community nursing service that effectively meets the health needs of the population within a primary care setting is the primary aim of the public health nursing service.

The HSE's primary, community and continuing care service in County Galway, which has responsibility for public health nursing services in the county, continues to make every effort to protect and maintain front-line services. Thanks to significant staff commitment and as a result of redeployment and revised arrangements for cross-cover, Roundstone will be covered by the primary care team nurse based in Clifden.

In the wider context of Connemara, a level of locum cover will be provided to ensure that essential public health nursing services are maintained throughout the area. The Aran Islands have public health nursing cover at present and it is the HSE's intention that this cover will continue to be provided. Individual staffing situations will be considered in light of existing resources and the challenges imposed by the recruitment moratorium.

Contingency planning is ongoing to ensure quality safe services can be delivered following the retirement of staff from services at the end of this month. The HSE is currently carrying out a review of public health nursing services, which is expected to be completed shortly. This review will inform national HSE policy in order to facilitate the integration of services and the delivery of efficient and safe care to patients in the community.

I want to give the Senator an assurance that I see a very bright future for community nursing and public health nursing in particular. I believe they will become the mainstay of primary care services. I look forward to receiving the report from the review group and to restructuring the way in which we deliver public health nursing services but I see them as being an absolute essential in terms of the rollout of enhanced primary care services.

Trevor Ó Clochartaigh (Sinn Fein)
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I am concerned about the position in terms of the answer I have got from the Minister of State. The public health nurse in Clifden under the primary care team is under pressure as matters stand and I would question if she is in a position to also cover this area. The Minister of State said the level of locum cover would be provided in the wider context of Connemara. Will she clarify what she means by that?

Róisín Shortall (Dublin North West, Labour)
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Sorry, Senator-----

Trevor Ó Clochartaigh (Sinn Fein)
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The Minister of State said: "In the wider context of Connemara, a level of locum cover will be provided to ensure that essential public health nursing services are maintained throughout the area." What does that mean?

Róisín Shortall (Dublin North West, Labour)
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I do not have the detail on that. It is a service matter for the HSE but I have been given an undertaking that cover will be provided. It do not believe anybody is under any illusion about the kinds of challenges that will face us in the health service at the end of this month. It will be difficult, of that there is no doubt. What I am seeking to do in the primary care area is to ensure that we can recruit a certain number of front-line people. We have managed to secure €20 million to fill vacancies. We do not know at this point the exact number of vacancies that will arise in primary care but, to the greatest extent possible, we will use that ring-fenced money to fill vacancies at the coalface, professionals providing the services on the front line. That will be done by employing people but there is an employment control ceiling by which we are bound. If it is a case that our allocation of posts is used up, we will then have to take another approach in terms of employing people on a sessional basis, ensuring that we get much greater flexibility from the services that are in place. We were promised that the Croke Park agreement would deliver that kind of flexibility and that will be tested in the coming months.