One third of HSE areas have curtailed public health nursing to priority cases, new figures show, raising concerns that children are “being left behind”.
Public health nurses (PHNs) are qualified general nurses and midwives employed by the HSE to deliver free community-based healthcare.
They provide important development checks for children from birth to five years of age. Appointments are typically conducted in the family home or at a local health centre.
Data from the HSE shows that seven of the 20 integrated health areas have caseload prioritisation in place to some extent.
These are: the Cavan/Monaghan IHA, Dublin South City and West, and some areas within Dublin South and Wicklow, Dublin North City and West, Dublin North County, South Cork and Dublin South West.
Under prioritisation, rather than delivering universal, routine check-ups to every household, services are triaged so that infants, children, or adults with proven medical risks, disabilities or immediate clinical vulnerabilities are seen first.
Consequently, routine and non-priority developmental assessments may be delayed, limited or suspended for many babies.
The HSE data also shows there has been a small reduction in PHN staff since December 2020, falling from 1,557 whole-time equivalents to 1,535 at the end of last year. Four of the six HSE regions saw a decrease in staff.
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The figures were obtained by Labour’s health spokeswoman Marie Sherlock, who described them as “deeply alarming”.
“PHNs are the first line of defence when it comes to identifying developmental, child welfare and maternal wellbeing issues and the least expensive part of the health system,” she said.
“It is simply unacceptable that we now have less public health nurses across the whole country than five years ago and it flies in the face of the commitments to increasing care in the community.”
Sherlock said parents have reported cases of the four-year check being replaced with a phone call in which they are asked if they have any concerns, and that the file is closed if they do not.
She added that nurses have told her they feel “overworked and under-resourced”.
“We need a specialised workforce plan particularly targeting deployment of new staff to areas of social deprivation and ensure that new pathways are opened up for paediatric nurses to become PHNs,” she said.
The HSE’s performance committee in May discussed the regional variation of PHN assessments, with concerns being raised about the “low rates” of child health and development checks in some areas.
The HSE has previously acknowledged the challenges with the recruitment and retention of PHNs, particularly in the Greater Dublin Area.
The HSE said it introduced short-term measures to tackle the issue, including service integration, workload reorganisation and staff redeployment.
“Where staff shortages occur, the HSE prioritises and supports children and families with the greatest need in the community.”