Written Answers. - Child Health Services.
Pat Rabbitte
Question:
205
Mr. Rabbitte
asked the
Minister for Health
if he will establish a senior working party to review the community health services for children generally; if he will outline when the last such working party reported and its principal recommendations; and if he will make a statement on the matter.
A working party made a report to my Department in 1967 on the child health services and this report forms the basis for the services presently in operation in this country. A summary of the recommendations is set out in the table to the reply.
All the child health schemes are constantly kept under review in my Department and in the health boards where they are administered. Consideration is at present being given to the necessity at this time to establish another working party to review child health services.
Summary of Recommendations
1. All children should have a scheduled medical examination when they reach the ages of 6 months, one year and two years. (Par. 3.5).
2. In urban areas with a population of 5,000 or more persons, the scheduled medical examinations for pre-school children should be carried out in clinics by doctors on the CMO's staff; in smaller towns where Child Welfare Clinics are now operating, the clinics could be retained if the CMO desires it. (Par. 3.6).
3. In rural areas and towns without clinics, the scheduled medical examinations for pre-school children should be undertaken by general practitioners who have made agreements with the health authority. (Par. 3.8).
4. The school should continue to be used as the basic centre for school health examinations. (Par. 3.13).
5. ACMOs should continue to carry out school medical examinations. The question of allowing general practitioners to participate in this work could be reconsidered if an acute problem in recruiting ACMOs arises in the future. (Par. 3.14).
6. The aim of three routine medical examinations during a child's national school career should be replaced by the following system:— a comprehensive medical inspection of all children between the 6th and 7th birthdays; routine annual screening by the district nurse for vision, posture, cleanliness; audiometric testing of special groups; a selective medical examination of nine-year-old children (a proportion would be selected for examination); the examination in any year of a child referred by the parent, teacher, or district nurse; some children would also be due for reexaminations. (Par. 3.18).
7. The School Medical Officer would visit schools at least once a year. (Par. 3.18).
8. In small schools (e.g. under 30 pupils) it may be more practicable to examine all the children in the school every two years. (Par. 3.19).
9. Doctors providing services under the Maternity and Infant Welfare Service (which extends to 6 weeks after birth) should be required to undertake a scheduled medical examination of the infant at the age of 4-6 weeks, using an appropriate record card. (Par. 3.23).
10. The maintenance by the CMO of a register of all pre-school children would be a valuable aid to the efficient running of a child welfare service. (Par. 4.4).
11. An appointment system for mothers due to bring their infants to clinics for a scheduled medical examination would be extremely desirable. (Par. 4.10).
12. The nurse should control access to the doctor in a Child Welfare Clinic, deal with mothers who come specially to consult her and organise associated health education activities. (Par. 4.11).
13. Where the Child Welfare Service is provided by the general practitioner, the child's Record Card should be retained by the CMO after the final periodic examinations at the age of two years and should subsequently be associated with the School Health Service. (Par. 4.18).
14. In clinic towns, the general practitioners providing the Maternity and Infant Welfare Service (up to six weeks of age) should make available to the CMO certain medical records in time for the six months examination of the infant in the clinic. (Par. 4.20).
15. Everyone directly concerned with the health of the school child — parent, teacher, doctor, nurse — should work together as a school health team. (Par. 5.2).
16. The initial consent sought from parents before an examination of their child under the School Health Service should cover all examinations by doctors and nurses in the school during subsequent years. The parents could withdraw the consent at any time. (Par. 5.3).
17. A special questionnaire should be completed by the parent of each child being examined under the School Health Service (Par. 5.8); a parallel aim would be to secure the maximum attendance of parents at the examinations. (Par. 5.9).
18. If the School Medical Officer finds a condition in a child which adversely affects the child's educational capacity, he should inform the teacher so that allowance would be made for the child in the classroom. (Par. 5.11).
19. The needs of school medical examinations should be taken into account in the design of new national schools. (Par. 5.12).
20. Information on the teacher's role in the School Health Service should be systematically given in Teachers' Training Colleges and to serving teachers (Par. 5.13).
21. We estimate that about 90 doctors would need to be employed by health authorities for the Child Welfare and School Health Services, on the assumption that two-thirds of their working time was devoted to these services (Par. 6.5). At present 76 doctors are engaged in the Child Health Services but there are great variations in the proportion of time which they can devote to the services.
22. The DCH should be substituted for the DPH as an essential qualification for post of the ACMO. A special inservice course for new entrants to the ACMO grade should be organised and would comprise social and developmental paediatrics and certain public health material covered by the present DPH. (Par. 6.8).
23. Existing ACMOs should be given refresher courses of 4-6 weeks duration, covering clinical paediatrics, developmental paediatrics, mental handicap and its assessment, and child health services. (Par. 6.9).
24. Women doctors with the DCH who are married should be permitted to provide Child Welfare and School Health Services on the basis of a temporary appointment. (Par. 6.10).
25. The proportion of the ACMO's effective working time which is available for the Child Welfare and School Health Services should be about two-thirds and should not be reducible at will as soon as other pressures arise. (Par. 6.11).
26. There should be more flexibility in setting the official working hours for ACMOs so that they can make the best use of the relatively short school day. (Par. 6.12).
27. The co-operation of the medical profession should be sought in order to increase awareness of developmental paediatrics among general practitioners participating in the proposed Child Welfare Service. (Par. 6.13).
28. One public health nurse in the CMO's office should be assigned to each ACMO to assist him in his visits to national schools. (Par. 6.15).
29. Additional paediatric clinics should be provided up to the level where there is one monthly clinic to every 7,000 children aged 0-14 years. Children should be seen within a month or so of referral. (Par. 7.5).
30. ENT clinics are urgently required in areas lacking a clinic service at present, or which have excessive waiting lists. (Par. 7.11).
31. School Medical Officers should not refer children direct to hospital for tonsillectomy except where the reasons are compelling. Cases appropriate to the general practitioner should be referred to him rather than to the ENT clinic (Par. 7.12).
32. The capitation system of payment to ophthalmic surgeons who hold clinics for health authorities should not be extended to areas where sessional arrangements (i.e. fixed remuneration per session) now operate. Whenever a particular ophthalmic surgeon ceases to hold a clinic, the sessional method of payment should be retained or introduced in any new arrangements (Par. 7.19).
33. The development of speech therapy facilities should be vigorously pursued (Par. 7.20).
34. The role of the district nurse, as the link between the homes in her district and the health services, should be specifically recognised in the mental illness and mental handicap services (Par. 7.27).
35. All necessary steps should be taken promptly to improve the out-patient specialist services where they are deficient and they should be maintained in a high state of efficiency (Par. 7.28).
36. In general, entitlement to free treatment under the Child Welfare and School Health Services should depend on the parents opting for the services and the child participating satisfactorily in the various examinations offered. Subject to option and participation, the present entitlements for free treatment under the Child Welfare and School Health Services should be modified as follows: the 10/- daily hospital charge (public ward) for both pre-school and national school children in the middle income group should be waived irrespective of when, where or by whom the defect was discovered; certain long term defects should be scheduled and children of any income group automatically entitled to free out-patient and institutional treatment for them irrespective of whether they had opted for the Child Health Services; higher income group children should, for the first time, be entitled to free specialist out-patient treatment for any defect noted at a child welfare examination, and should retain their entitlement to free out-patient specialist services under the School Health Service; the present eligibility of higher income group children in national school to free short term hospital treatment should be removed and reliance placed on Voluntary Health Insurance; children of all income groups should be entitled to free treatment and appliances for dental, ophthalmic and hearing defects irrespective of where or by whom the defect was discovered. The White Paper on the Health Services envisages the abolition of out-patient specialist charges for the middle income group (Par. 7.36).
37. Entitlement to free treatment (apart from treatment for specified long term defects) under the Child Welfare and School Health Services should depend on the parents opting for participation in these services, and on the child coming forward to a reasonable extent for the various examinations offered (Par. 7.37).
38. Health education should be the subject of a special study (Par. 8.3).
39. Positive steps should be taken to persuade mothers of the benefits for their children of the Child Welfare and School Health Services (Par. 8.4).
40. The various schemes aimed at improving the nutritional standards of mothers or children should be viewed in an integrated manner and the need for them assessed in the context of current circumstances. In particular the School Meals Service should be re-appraised (Par. 8.6).
41. The three services concerned with children — the Maternity and Infant Welfare Service, the Child Welfare Service and the School Health Service — should be regarded as forming a continuous whole, tracking the developmental progress, and supervising the health of the child. These three services should be renamed the Child Health Services (Par. 8.7).
42. Every effort should be made to push back the screening processes to earlier stages. In particular, more effort should be devoted to health screening at birth and in the neo-natal period. (Par. 8.8).
43. The Department of Health should administer the Child Health Services in an active manner (Par. 8.9). It should collect reliable statistics as an aid to evaluation and administration of the services (Par. 8.11).
44. There is a case for a selective examination of post-primary day pupils at the ages 14-15 years; an extended School Health Service could also followup, where necessary, pupils under medical observation from national schools (Par. 8.14). The School Health Service should not be extended to post-primary groups until the service in national schools is working satisfactorily (Par. 8.15).
45. The treatment facilities under the service envisaged for national schools should not be extended to post-primary schools. The proposal in the White Paper on the Health Services to extend the dental, ophthalmic and aural services to the middle income group would meet the main needs of post-primary pupils (Par. 8.16).
46. If possible, facilities granted to post-primary pupils should be granted also to their contemporaries who have dropped out of the educational system (Par. 8.17).
Pat Rabbitte
Question:
206
Mr. Rabbitte
asked the
Minister for Health
if he will outline the amount of (a) capital and (b) revenue which has been spent on child health services since the health boards were established; if he will give details of the estimated capital base of the child health services as compared to the overall capital base of the health service; if he will categorise both the capital and non-capital figures for, (a) hospitals, (b) children's hospitals, (c) health centres, (d) family doctors and (e) other facilities used by children; and if he will make a statement on the matter.
The information sought by the Deputy is being collated by my Department and I will have it sent to him as soon as possible.
Pat Rabbitte
Question:
207
Mr. Rabbitte
asked the
Minister for Health
if he will outline the amount he proposes to spend for the next two years on child health services; and if he will further outline the development plans, if any, he has; and if he will make a statement on the matter.
Pat Rabbitte
Question:
208
Mr. Rabbitte
asked the
Minister for Health
his views on the future of the community paediatric development services; if he will outline the amount which has been spent each year in real terms per child since 1970 on this service; if he has satisfied himself with the resources currently available to run this service; and if he will make a statement on the matter.
Pat Rabbitte
Question:
211
Mr. Rabbitte
asked the
Minister for Health
if he will give details of the numbers of children who availed of health services each year since 1970 classified under the headings (a) hospital, (b) family doctor and (c) health centre; and if he will make a statement on the matter.
Pat Rabbitte
Question:
212
Mr. Rabbitte
asked the
Minister for Health
if he will outline the size of the waiting list, the average waiting time and the longest waiting time for all services including consultant services, speech therapy, psychological services, occupational therapy and other services in respect of children provided by, (1) the family doctor, (2) the school medical officer, (3) the school nurse, (4) the school dental services and (5) child paediatric development services; if he will give details of the length of time a child has to be waiting for services before the delay constitutes an effective denial of that service; the number of children that are, in his estimation, effectively denied services to which they are entitled in this manner; and if he will make a statement on the matter.
I propose to take Questions Nos. 207, 208, 211 and 212 together. It is not possible at this time to outline the amount it is proposed to spend in the future on the child health services. The resources currently devoted to running the child health services, including the community paediatric development services, must compete on an ongoing basis with other worthy projects for which my Department has responsibility and while I would like to spend more on the child health services it is my duty to spend the finite resources available to me in the best way that I can.
The detailed information requested by the Deputy in relation to the number of children who availed of the health services in various settings, by whom they were examined and the length of the waiting lists is not readily available. I will request the chief executive officers of each of the health boards to ascertain this information in respect of their own area and to convey this information directly to the Deputy.
