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.