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28 September 2006 Edition

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The Health Crisis: Public Health Centres under strain

Serious backlog in infant health check-ups

As Sinn Féin builds for a major rally on the 26 County Health Crisis in Dublin on 21 October, ELLA O'DWYER talks to Sinn Féin's Dublin Mid West general election candidate Joanne Spain about one aspect of the health service that is causing major hardship.

Joanne Spain is regularly approached by mothers of newborn babies expressing concern at the serious backlog of infant health check-ups available to them. Health clinics in Dublin are predominantly staffed by public health nurses. In 2001 there were 693 public health nurses and by 2005 the number had fallen to 686, despite big population growth in areas such as Lucan.

"The health centre in Lucan has a catchment area of around 30,000 people and provides a public health nurse service to new mothers. When the mother returns from having a baby in hospital, she is meant to have a visit from a public health nurse from between a couple of days to a week of being discharged. The health nurse's function is to give the new mother advice on nutrition and childcare and to detect postnatal depression or other problems related to the mother and child's welfare. It's an absolutely vital service.

One woman who came to see me said that when she went home nobody came to see her or the baby. Another spoke of being left for two weeks without a visit from a nurse. If a woman is suffering postnatal depression, a lot can happen in two weeks. If for instance a young teenage mother has not been shown how to nourish her child, what bottles or milk she should be using, these are the things a public health nurse will teach her," Spain says.

The woman in Lucan hadn't had a visit from the public health nurse because the nurse was on holidays. A nurse from a different district told her she would have to take the baby down to the clinic herself.

According to Spain: "This clinic sits for three hours on a Wednesday and the same staff sit for about two hours in a separate clinic in Ballyowen on a Tuesday. You're talking about a very limited timeframe and you're asking a woman who's just had a baby to take the child down to the clinic and wait in a very busy waiting room. It doesn't encourage new mothers to go and get seen."

Later on, the baby is meant to have a vital developmental check-up at around nine months and again at a year. "Lucan clinic has cancelled the nine month check altogether and put the one year check back to a year and a half because they are so understaffed." The mother therefore could be relying on advice from a GP, who will charge €50 at a minimum, while the health clinic is free.

Sinn Féin has this week submitted Parliamentary Questions on this issue to Health Minister Mary Harney through Dáil group leader Caoimhghín Ó Caoláin.

Again, in the area of dental care, the backlog for free dentists is so great that parents are having to take their children to private dentists - at great expense.

Spain lays the blame for these grave inadequacies in the public health sector on the government's and Harney's obsession with private healthcare: "The whole problem with the public health sector and these health centres is lack of government funding. Harney's privatisation agenda is taking funds away from the public sector, so that the public health centres are falling by the wayside. These centres are absolutely crucial for people in working class communities. They're not just the first point of call for new mothers but also provide free eye and dental exams.

"A consultant can earn in the region of €1 million a year. The Irish Nurses Organisation at their conference a few months ago said they felt that the centres were understaffed and underfunded. As far back as 2001 they were warning that there were backlogs in relation to the centre in Lucan. They threatened to go out on strike in protest over overcrowded and dirty working conditions. They simply couldn't keep on top of what the centre was expected to do."

For Spain, proper primary care is vital. "Ten per cent of people needing medical attention do not require hospitalisation but 90% do require primary care. That includes maternity care, aftercare, treatment of diabetes, broken arms, childcare etc. The government only invests 19% of the health budget into community care - health centres, public health nurses, public health doctors. That's completely disproportionate to the amount of healthcare that can be dealt with at a primary care level.

"They're building super regional hospitals where only ten percent actually need to be dealt with. That's why we have a crisis in A&E. People end up going into hospital to get things dealt with that could have been treated without hospitalisation."

On medical cards, Spain says: "Even within working class areas, the levels qualifying for medical cards are so low you'd have to have practically nothing. Sinn Féin wants cards for everyone under 18. While people over 65 qualify for free healthcare, they come under the public healthcare service and a lot of older people will tell you that they get put to the bottom of the queue simply because of their age. So they get free healthcare but they don't get the service they deserve."

Sinn Féin is seeking a Community Health Partnership to strategically plan and have an oversight role on community services and local hospital services. It would oversee all health services at primary care level. Health professionals and people from the community would make up the partnership. This body would co-ordinate and evaluate the needs of any given area. This requires funding but the dividends would be very high. "It is estimated that such a project could help to realise in the region of €30 billion a year in healthcare saving. As things stand, a lot of GPs tend to set up in more affluent areas and are not likely to set up in poorer estates unless the government directs them to do so. That's where we would see the Community Health Partnership coming in. The Partnership would direct amenities where they are most needed," Spain says.

"Mary Harney has decided privatisation is the answer. It's not an answer for people in the housing estates in Lucan or Clondalkin that I visit where people will never be able to access the private health system. Women there will never be able to afford to have their babies in private healthcare, where they would have to pay €3,000 to stay in a private room for four nights. Harney needs to pull her fingers out of her ears, stop this mantra of 'private care will fix all our ills' and start doing her job properly."

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