Mark Daly (Fianna Fail)
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I welcome the Minister to the House and thank her for being here today. There was a bit of a mix-up last week with Senator Ní Chuilinn's Commencement matter. I appreciate the Minister coming in specifically to answer this Commencement matter. Before I call on Senator Ní Chuilinn, I welcome to the Distinguished Visitors Gallery my niece Yvonne Daly, who is also my godchild and will at some stage be selecting a nursing home for me. I ask the Minister to make sure she picks a nice nursing home for me some day in the future. The Minister might keep an eye on her when she does. I also welcome her friend Katie Dillon. They were out at a concert last night and were up bright and breezy this morning to come and watch Seanad Éireann in action.

Evanne Ní Chuilinn (Fine Gael)
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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.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank Senator Ní Chuilinn for raising this important topic and again apologise for the problem last week.

The Government remains committed to providing continued investment in the health workforce, including public health nurses, and ensuring this incredibly important service is available for those who need it. Public health nurses are employed by the HSE to deliver safe, quality and person-centred community nursing care across a person's life. As of May this year, there are 1,493 whole-time equivalent, WTE, public health nurses employed and a further 27 whole-time equivalent posts provided for in budget 2025.

In response to the very significant concern the Senator and others have raised, especially in her constituency where I have observed this has been a particularly acute problem, we have tried to expedite those posts to areas where child health developmental assessments are most impacted. More broadly, as of March 2025, 83.4% of 9- to 11-month child developmental assessments were completed on time or before reaching 12 months of age.

As we are aware, the HSE recruitment pause ended in July 2024. There is no impediment to normal recruitment or replacement of staff within agreed WTE limits. Each regional executive officer will continue to prioritise, recruit and replace staff within his or her approved number as appropriate, including public health nurses.

The Senator and I both know there have been known challenges with the recruitment and retention of public health nurses, especially within parts of Dublin and in particular in the area the Senator represents. A community nursing oversight group was established by the HSE specifically to identify those challenges related to recruitment and is progressing the recommendations from that work. Short-term temporary solutions to prioritise resources and service provision have been put in place, including prioritising birth notification visits and post-natal assessments.

As of March this year, 13 local health offices nationally, including Dublin south-west, are using the national caseload prioritisation framework. That assists with providing care to people within the areas in greatest need of services. Child health developmental assessments have, in some instances, been impacted by that approach. However, and this is so important, the HSE advises that the Dublin south-west integrated healthcare area, IHA, which covers the area of Dublin 12, is working to address service provision. Efforts under way include the development of partnerships between acute hospitals and community partners to provide graduate nurses with an opportunity for a clinical rotation to the community and to initiate a similar opportunity for experienced registered nurses working within hospitals. That development is in the initial stages and is one of a number of measures that will improve the public health nursing workforce into the future.

Of the additional public health nurse posts allocated in budget 2025, six whole-time equivalents were allocated to Dublin south city west and Dublin south-west IHA’s, which are areas with a significant mismatch between demand and capacity as the Senator correctly identified. Recruitment for these positions has been prioritised. Candidates have been selected and are scheduled to commence their roles through the public health nursing sponsorship scheme in September 2025. That is six additional WTEs for that area commencing in September 2025. Reconfiguration and integration of services, reorganisation of existing work and redeployment of staff will continue to underpin broader contingency plans. I absolutely fully acknowledge the very important concerns of parents when access to these important public health nursing services is limited. They provide reassurance and comfort as well as an early identification system for difficulties at a most vulnerable time of both a mother and baby's life. My Department is working with the HSE to address those challenges and I will continue to do so. I appreciate the Senator raising this issue and the opportunity to be able to provide an update to her today.

Evanne Ní Chuilinn (Fine Gael)
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I thank the Minister. That piece of information on the six additional whole-time equivalent nurses is new. If they are beginning in September 2025, that will significantly impact in a positive way in the Dublin areas the Minister mentioned. If she has an opportunity to pass word back to the HSE and the managers in the area, it is important that, as part of that workload in September, they would look at trying to catch up on what has been missed because babies continue to be born and continue to need their newborn checks, six-week checks and six-month checks, but there are three- and four-year-olds who have had maybe one heel prick test and that is it. It is, therefore, really important that, as part of their work programme when they begin in September, they look back at what has been missed over the past few years. I appreciate the Minister's considered response, however. I am glad there is actual news in it and that we have six whole-time equivalent public health nurses beginning work in September. I thank her for that.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I know that the Senator has been a very strong advocate for this area. It is my privilege to be able to provide this update to her. I thank her for raising this so that I could provide this update to her very publicly and her constituents. Perhaps we might have a further conversation a number of months into their work from September 2025. I will certainly bring the Senator's suggestion back to the HSE. Again, I thank her for advocacy.