Wednesday, 27 June 2018
Nursing Staff Recruitment
I thank the Minister of State, Deputy Jim Daly, for coming to the Chamber to deal with the issue of public health nursing in north Dublin. The north Dublin area of the HSE covers areas, including Balbriggan, the Naul, Skerries, Garristown, Oldtown, Lusk, Rusk, Swords, Ballyboughal, Malahide and Portmarnock, as well as other areas such as Darndale, Baldoyle, Coolock, Raheny, Artane and Howth. This area covers a population of over 300,000. It is the most rapidly growing area in the country and, I believe, one of the most rapidly growing areas in Europe. As a consequence, it has a very young population. By way of a parliamentary question put down by one of my colleagues, I have learned there are just 64 public health nurses covering this area, which is wholly inadequate for the size of population and the fact it is a very young population. This is simply not good enough.
As the Minister of State knows, public health nurses play a vital role in our community. They liaise with GPs, practice nurses, hospices, hospitals and meals on wheels, and they make sure that citizens can access the health services in a timely and proper manner. They often keep a register in their offices of older people in the community and make periodic calls to their houses just to take care of the community. Vitally, they visit mothers and their babies in their homes in the days and weeks following the birth of the child. This is vital for the health and well-being of mothers and their children. They distribute vital health and safety information in regard to sleeping arrangements, sterilisation, vaccinations and breast feeding, and check on the mental health of the mother, which is vital for the health of the child and the overall health of the family unit.
They also look out for signs of domestic violence in the home. We know from studies that the periods before birth and immediately after birth are the periods of most vulnerability for women who are in domestic violence situations. It is very important they are given support, and public health nurses are often the only person from outside the family unit coming into the home who could see warning signs. However, if public health nurses are seriously over-worked and need to get to a number of different houses on that day, they do not have the time or resources to dedicate to getting to the bottom of very complex issues such as domestic violence.
I would very much worry for the public health nurses in north Dublin who are seriously over-worked. They are dedicated and offer a great front-line service but we do not have enough to service a population of more than 300,000. I would like the Minister of State to outline his plans and the Minister, Deputy Harris's plans in regard to the HSE plan to hire and assign more public health nurses for the north Dublin area. This needs to take into account the actual population and the projected population because much of the housing being built at the moment in Dublin is being built in north County Dublin, so the population is growing rapidly as well as being a very young population - the youngest in the State. If public health nurses calling to mothers in their homes are expected to do the best job they can, they need additional numbers. I would appreciate a response from the Minister of State.
I thank Senator Clifford-Lee for raising the issue of the number of public health nurses currently serving the Dublin north area. Both the Minister, Deputy Harris, and I understand and appreciate the excellent care these nurses provide to local communities and are anxious to ensure appropriate staffing levels across the country.
The Department of Health published Working Together for Health - a National Strategic Framework for Health and Social Care Workforce Planning in 2017. This document provides an integrated, dynamic and multidisciplinary approach to workforce planning at all levels of the health service, and the HSE is currently working to operationalise the framework across the health sector. The implementation will be guided by the relevant work streams of the Health Services People Strategy 2015-2018 and Government policy on public service numbers and costs more generally.
As part of this overall workforce planning process, there are a number of recruitment and retention initiatives that seek to bolster nursing capacity. These include offering permanent posts to graduate nurses, continuing the process of pay restoration and offering new opportunities for career development. Turning specifically to public health nurses, these staff are recruited through the public health nurse graduate programme. Each August, the HSE places qualified nurses on placement in the different community health care organisations following an interview process. These nurses are referred to as the public health nurse student intake, and alongside their placement in the community, they participate in an academic programme. The students graduate one year following their entry into the programme and then take up permanent positions following their formal registration.
In 2017, 140 public health nurse students participated in the programme and will graduate in August. These graduates will be offered permanent public health nurse contacts in CHO 9, as follows: Dublin north - 12 public health nurse graduates; Dublin north west - 16 public health nurse graduates; and Dublin north-central - nine public health nurse graduates. In addition, 27 public health nurse posts in CHO 9 that are vacant as a result of retirements, long-term sick leave or career breaks will be filled through the 2018 public health nurse intake programme. These students will graduate in 2019 and will be offered permanent contracts across the Dublin north region. Moreover, I am pleased to be able to inform the Senator that, in recognition of the needs of the Dublin north area, CHO 9 has been allocated seven new development posts for public health nurse nursing. These students will take up their placement in August 2018 and will graduate in August 2019, when they too will be offered permanent contracts. This increased allocation of public health nurse posts will ease the pressures currently being experienced in Dublin north and help to further improve and enhance the delivery of primary care services in the local area.
I thank the Minister of State. I am glad to hear of those additional recruits but, to be honest, I think it will just be a drop in the ocean. I would like to know the intake numbers into the public health nurse graduate programme and whether the Government is going to increase the numbers rapidly to deal with the rapidly growing population. To have 12 public health nurses graduating and being allocated to Dublin north is, as I said, welcome but it is just a drop in the ocean. We are trying to play catch-up and we are not going to catch up quickly enough with these numbers, unfortunately.
I note the Senator's concerns. It is a difficult balance to get all of these staffing challenges right. One cannot push too many nurses into the public health nurse programme without leaving the acute side short, so it is about getting the balance right and trying to manage the available resources, while trying to increase the overall intake of nurses. As I outlined, there is a workplace planning programme in place to try to address that infrastructural deficit at the base level. When we can increase that number, we can then increase the overall numbers. I have outlined some positive steps, which the Senator has acknowledged.I also appreciate the Senator's concern that it may not go far enough to resolve the issues. I am happy to pass on the additional information she sought.