Dáil Éireann debate -
Thursday, 5 Mar 1998

Vol. 488 No. 3

Adjournment Debate. - Childhood Immunisation Programme.

Ms Clune

Prior to 1996 public health nurses participated greatly in the implementation of the childhood immunisation programme. I refer to the three in one and polio injections given to babies at two months, four months, six months and the MMR — measles, mumps and rubella — injection, which is given from 15 months onwards.

Prior to 1996, public health nurses were informed of a baby's existence, could communicate with the mother and ensure that the baby was immunised. It is a busy time for a family and it can be difficult to keep track of a child — two months is nothing when one has a small baby. The public health nurses worked well in ensuring babies were immunised.

After 1996, however, the situation changed. In consultation with GPs, but not with public health nurses, the Department of Health implemented a new scheme in 1996 under which GPs were made responsible for administering the immunisation. Public health nurses refused to participate in the scheme because they had not been consulted when it was drawn up or were not informed of the changes. Prior to l996 they administered the immunisation as part of their job. GPs are now paid a fee to do so.

I raised this matter in the form of written questions to the Minister on a number of occasions. It is not surprising the scheme is not effective as a major prong, the public health nurses, is missing. The original uptake target was 95 per cent, but the figures from the Department of Health and Children indicate that the figure may be as low as 65 per cent in some cases, which is alarming. We have the necessary information and a vaccination scheme in place, but there is not a proper mechanism to ensure children are immunised. Public health nurses have called for a major review of what they consider a flawed vaccination programme. GPs claim they are doing all they can to implement the scheme but are hampered by the nurses' refusal to work under it. The INO has refused to take part in the initiation process of infants although it is advising parents to have their children immunised.

Approximately 45,000 babies are born each year. If there was only a 65 per cent take-up in some cases, have some babies not been immunised? Figures indicate there has been an increase of the incidence of whooping cough, but the immunisation scheme cannot be blamed for that. How does the Minister propose to resolve this difficulty to ensure public health nurses participate in the scheme and that all babies are immunised?

Mr. Martin

I have been asked by the Minister for Health and Children to take this matter on the Adjournment. I thank the Deputy for raising this important issue. She has identified the difficulties pertaining to the immunisation scheme, particularly the role of public health nurses. The Minister is particularly conscious of this problem.

The Review Group on Primary Childhood Immunisation was established in November 1993 to review the administration of the childhood immunisation programme and to make recommendations on measures, having regard to both cost and quality issues, on options to improve the uptake of immunisations.

The group was established against a background of relatively low uptake of the recommended primary childhood immunisations in certain areas of the county and among specific groups, and a parallel high incidence of certain infectious diseases. The group recommended that the general practitioner should be the principal health professional involved in delivery of primary childhood immunisations. His or her role as the family doctor means the GP is ideally placed to encourage parents to have their children immunised, to provide advice and information taking account of the medical history of the child and family, to administer the immunisations, to deal with any reactions and to follow up children who do not attend for immunisation.

The aim of the immunisation programme is to eliminate, as far as possible, such conditions as diphtheria, tetanus, polio, hib disease, measles, mumps, rubella and pertussis. The review group concluded that it may be possible to eradicate these diseases if an uptake level of 95 per cent of the child population is achieved and maintained.

In December 1995 agreement was reached between the Department of Health and the Irish Medical Organisation on the administration of the programme. This agreement had immediate effect. Health boards were required to make substantial changes in the delivery of the primary childhood immunisation programme in a very short period. In addition, the detailed arrangements for the new system had to be developed. These related to the payment structure, development of computer programmes, claim form and record systems. A sum of £2 million was allocated to health boards in 1996 to cover the net additional costs of the new programme. The additional amount allocated in 1997 was £757,000 and in 1998 a further sum of £556,000 has been provided in respect of the additional cost of the programme. This brings the total additional funding in 1998 to £3.313 million.

The target of 95 per cent immunisation of the age group has not yet been achieved. Returns from seven of the eight health boards indicate that uptake levels for completed DPT immunisations among children aged 18 months range from 72 per cent to 88 per cent. The Mid-Western Health Board has reported an uptake level of 42 per cent for children aged 12 months, but has advised that the actual uptake is significantly better as the board has a large backlog of claims from general practitioners to be processed. The Minister for Health and Children has been advised that additional staff resources have been put in place to address this problem.

One of the main difficulties being experienced relates to the non-cooperation of public health nurses in the operation of the new system. The public health nurses have always played a key role in the advocation, promotion and education of parents on the benefits of immunisation. Under the new scheme they are required to identify the contracting GP whom the parent wishes to immunise his or her child and to follow up children who do not attend for immunisation. However, public health nurses are not carrying out these duties, they feel aggrieved because they were not involved in the review process.

Officials from the Department of Health and Children met the Irish Nurses' Organisation on several occasions in an attempt to resolve the issue. The Department has proposed that the technical steering group, established to provide a mechanism for resolving any outstanding issues arising in the implementation of the new programme, should be reconstituted as an advisory group and its existing membership, which consists of the Irish Medical Organisation, health boards and the Department, should be extended to include two nominees from the INO. The INO welcomed this proposal, but refused to lift the ban on public health nurses' co-operation because of failure to reach agreement on a range of other issues, including annual leave and personal security, introduced by the INO. It should be noted that these additional issues do not concern childhood immunisation and span the entire health service. Some of the issues are currently under consideration by the commission on nursing.

The primary childhood immunisation programme has been designed to be convenient for parents and is free. Health boards are making every effort to ensure parents are aware of this and that they realise the importance of availing of the scheme.

The Minister for Health and Children is anxious to resolve the difficulties identified in the Deputy's contribution, particularly those relating to the participation of public health nurses in the scheme.