Opening Statement to Joint Committee on Health & Children

Opening Statement to Joint Committee on Health & Children

in relation to Public Health Nursing

Thursday 27th June, 2013

Good morning Chairman and members of the Committee.

Thank you for the invitation to attend the Committee meeting.

I am joined by a number of my colleagues:

Dr. Michael Shannon, Director, Nursing & Midwifery Services
Martina Queally, Area Manager, Dublin South East / Wicklow

Background:

The delivery of community nursing services that effectively meet the health needs of the population within a primary care setting is the primary aim of the Public Health Nursing Services. The continued development of Primary Care Teams is also being progressed, focusing on increased emphasis on care in the community and integration of services as outlined in the HSE National Service Plan 2013.

The multidisciplinary PCT provides health and personal social services as well as being the first point of contact for patients and clients in a local setting and ensures continuation and co-ordination of services. In the context of care and reform and the current drive toward an Integrated Health System, treating and delivering care to patients in more appropriate settings is an integral part of the role of the Public Health Nurse (PHN) and Registered General Nurse (RGN) working within the primary care team. Public health nursing in Ireland is continuing to evolve in response to the growing demand for health care services in the community.

Public Health Nursing Services:

Public Health Nurses provide an extensive range of services within the Irish health service. E.g.

Child health:

The provision of Children’s health services including post natal visits and developmental screening up to 6 years of age.

The role of the PHN service in safeguarding and protecting the health and wellbeing of children is also provided for in legislation (Child Care Act 1991; Children’s First Guidelines 2011).

Immunisation:

The provision of school health services. The school health screening programme (Best Health for Children revised 2005) and immunisation programmes are currently available to school going children in accordance with the National Immunisation Guidelines 2008.

Children and Adults with disabilities:

Public Health Nurses are involved in the assessment of need and the provision of services to children and adults with disabilities.

Older Adults:

Health policy endorses maintaining older adults in their own environment where possible. Older persons receive assessments and are provided with services including home care packages in accordance with need.

Terminally ill/Palliative Care Clients:

The Public Health Nursing Service is extensively involved in the support of palliative care and terminally ill patients in community settings.

Long Term Illness

Patients with long term illnesses are supported in the home setting.

Hepatitis C

Patients with Hepatits C receive services including the support of the public health nursing service in accordance with assessed need.

Public Health Nurses are a key conduit for the dissemination ofInformation and Advice on health to all sectors of the population.

In conjunction with its core services the Public Health Nursing Service has expanded its remit to also include the following:

-The development and expansion of community intervention teams (CITs) whose primary aim is the avoidance of unnecessary hospital admission and the facilitation of early discharge from hospitals.

-The development of the school immunisation programmeto include the education of PHNs to oversee immunisation under medication protocol. The schools vaccination programme is currently being delivered by immunisation teams (Area Medical Officers and PHNs) in many areas nationally; it is anticipated that this programme will be nurse led in the future.

-Support for the Clinical Care Programmes which help to facilitate the timely discharge of patients from hospitals. The aim is to allow patients to receive more rehabilitation at home, remain at home in the long term and to regain independence in daily activities.

-Support for the national newborn blood spot screening service. The Public Health Nursing Service is responsible for ensuring that the test is carried out following notification and that all babies residing in their area have been offered screening.

-Expansion of clinic based services were appropriate including assessment and treatment of wound care, continence, child health, adult health checks, diabetes clinics and parenting programmes.

- The delivery of complex care to patients in the community undergoing oncology treatment in a number of areas e.g. Donegal and Galway

Workforce:

There are currently 3,312 public health nurses on the register with An Bord Altranais of whom 2,402 are on the active file. In March 2013 the total number of nursing staff employed in the Public Health Nursing Service was 2,067 WTE, broken down as follows:

•15 Directors of Public Health Nursing

•122 Assistant Directors of Public Health Nursing

•1,512 Public Health Nurses

•418 Registered General Nurses

•43 Student Public Health Nurses

Since 2006 in order to streamline the sponsorship of student public health nurse training the HSE and 4 participating HEI’s (UCC, UCD and NUIG/ St Angela’s Collegehave undertaken a process of joint entry and recruitment. For the past number of years the 4 RDO’s in the HSE regions were requested annually to identify their sponsorship requirements based on service need. Sponsoring Local Health Office areas provide clinical placements to PHN students while they undertake the full time Higher/Postgraduate Diploma in Public Health Nursing. This year a total of 85 student public health nurse sponsorship places have been allocated: 14 West, 14 South, 27 Dublin North East and 30 Dublin Mid Leinster.

In 2013, Primary Care development funding of €20m will be invested to support the recruitment of prioritised front-line primary care team posts and enhance the capacity of the primary care sector. The 2013 National Service Plan has prioritised the appointment of approximately 250 Primary Care posts (including Public Health Nurses (PHNs), Registered General Nurses (RGNs), Occupational Therapists, Physiotherapists and Speech and Language Therapists). These posts are currently being recruited and appointed.

Analysis has revealed considerable variation across the 17 Integrated Service Areas in ratios of health care professionals to population, and to population numbers in areas of high deprivation. Based on this analysis, 70 Public Health Nurses and 37 Registered General Nurses will be recruited to Primary Care Teams under the 2013 Service Plan.

Review of Public Health Nursing

A review of Public Health Nursing Services was commissioned by Dr Michael Shannon, Director of Nursing and Midwifery with the assistance of the Public Health Nursing Service and the Institute of Community Health Nursing. An expert group was chaired by Dr Joe Clarke, Primary Care Clinical lead and the review was completed in March, 2012. This review has helped to inform future policy on the integration of services and the delivery of efficient and safe care to clients in the community.

Education. The programme educates students to be able to practice as competent, accountable, autonomous PHNs, with the ability to work in partnership with other members of the PCT and community based organisations and with the aim of maximising their contribution to health improvement. The student is educated within a national and international context on the principles, professional issues and health promotional aspects of public health nursing, and has regard to the needs of younger people and families, patients with chronic illnesses, people with disabilities, adults and older people in the community.

In relation to Children, younger people and families the programme addresses the following modules:

Theoretical perspectives on child developmental pathways in early and middle childhood
Public health nursing services for families with children (0-12 years)
Determinants of child and family health - Risk and protective factors which influence child health; the concept of prevention; Assessment of risk and vulnerability;
Child health surveillance and screening.
Child health promotion
assessment, planning, implementation and evaluation of nursing care in consultation with the individual/family/group/community and deliver in conjunction with the PCT members
Best practice in child protection - Legislation and policy in relation to child health, young people and families;
Developing a partnership with children, young people, families and communities
Multidisciplinary and interagency communication
Good Practice in Child Protection (Teamwork, Networking Collaboration)
Interdisciplinary Work in the Child Care Context, (Case Conferencing)

Conclusion:

Public Health Nurses and Community Registered General Nurses currently provide a comprehensive range of nursing and midwifery services as outlined within a context of unprecedented change and evolving service need as part of the primary care team.

Priorities for the future include:-

Developing the capacity and systems within the PCTs and across Health and Social Care Networks to deliver more complex and a broader range of care to communities which will includeresponding to:

-Additional requirements arising from the implementation of Universal Healthcare

-An increased emphasis on health promotion and well being for communities

-Increasing incidence of cancer and chronic diseases in an ageing population for whom more care will take place at or near patients homes

-Requirements for specialist nursing practice and the provision of nurse led services for sub-populations e.g. diabetes /chronic heart failure etc.

This concludes my opening statement and together with my colleagues we will take your questions.

Thank you.