Keith Swanick (Fianna Fail)
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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.

Simon Harris (Wicklow, Fine Gael)
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I thank Senator Swanick for raising this matter in the Seanad today, and for the opportunity it gives me to outline my views on public health nurses and primary care. I fully agree with the Senator, who has been a strong advocate for primary care for a long number of years, that if we are serious about breaking what is now an annual vicious cycle of overcrowding in accident and emergency departments in our acute hospitals, we must look at providing more services in the community and finally making real the phrase a decisive shift to primary care. This has a number of elements, including the new GP contract and looking at the role of practice nurses as part of this, and I absolutely believe the role of public health nurses is another element.

The Institute of Community Health Nursing, ICHN, was established in 1985. As the Senator knows, it is a professional and educational body representing community nursing in the Republic of Ireland. The ICHN has a history of supporting community nursing services through education, development and research, and through its professional development and collegial networks. Through its global and international networking forums and conferences, the ICHN demonstrates the impact of Irish community nurses in practice. I am happy to state the Department of Health has supported the work of the ICHN through regular engagements on matters of mutual interest, attendance at annual conferences and contributions to publications, and there is ongoing engagement with the chief nurse's office in the Department and the ICHN, and with other units in the Department of Health.

I assure Senator Swanick that I absolutely recognise the importance of recruiting and retaining nurses in the public health service. The programme for Government includes a commitment to expand the public health nursing service, which demonstrates how we value these services. There are 1,745 public health nurses, of which 1,498 are whole-time equivalent, in the health services. This year, 108 student public health nurses are in training. I am pleased to inform the Senator that a needs analysis is under way in the office of the nursing and midwifery directorate in the HSE to determine how many training places will be required this autumn. It is very important that we get this analysis and data correct. HSE management is committed to implementing a range of initiatives that will support future recruitment and retention.

In recent years, Ireland has made significant achievements in key outcomes relating to the health and well-being of the population, be it with regard to cancer, chronic disease management, cardiac care and life expectancy. However, challenges still persist, especially in accessibility to timely and appropriate health care and the growth in the number of people reaching older age, as the Senator mentioned. All of these indicators point to the growing need for an enhanced role at community level health care that best meets the health needs of patients in the home or as close to home as possible. This must also mean new roles and structures being developed for community nurses and midwives. These will build on the new community health care structures already in place, and with this in mind new policies being led by the Department will recommend the development of integrated acute and community nursing and midwifery practice to enhance patients' access to appropriate health care services. As we develop these policies throughout the year, I will keep in touch with Senator Swanick.

The shift of health care from a focus on hospital to a focus on primary and community care will play a real part in achieving the integrated care for patients for which Senator Swanick advocates. The ICHN should continue to play a pivotal role in contributing to the development of these new policies and in supporting these professionals in education, development, research and networking through their professional development and networks.

With regard to funding arrangements for the ICHN, the HSE has informed me it has provided funding for the institute in recent years. On foot of this debate, I have asked the HSE to provide the Senator and me with a report on the funding requirements and funding provided to the ICHN and I will revert to the Senator when I receive this.

Keith Swanick (Fianna Fail)
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I thank the Minister for his response and I welcome the fact there may be a review of funding for the organisation which does invaluable work. It receives a very small amount of money for the work it does. I thank the Minister for coming to the House to explain it.