Child health nurse cuts to put pressure on GPs

The role of the family and child health nurse in Tasmania is fast eroding, Flynn Murphy reports.

A push to have mainstream health services play a greater role in family and children’s health in Tasmania has raised concerns that general practitioners do not have the skills or time to do the job effectively.

Australian Nursing Federation Tasmanian branch secretary Neroli Ellis told Nursing Review child and family health nurse numbers in the state were being eroded.

“[The health department is] further reducing family and child health nurses so that they will be doing the normal child health clinics only for ‘vulnerable families’, and anyone who can afford it will have to go to GPs,” Ellis said.

However she said the ANF was concerned GPs did not have the appropriate skills or time to take on these cases.

Her comments follow reports in the Examiner newspaper last month that the state’s 95-year-old Child Health and Parenting Service (CHAPS) was to be cut completely, due to a tightening health budget.

While the Tasmanian Department of Health and Human Services has denied this, it has confirmed changes will be made to the program that provides universal healthcare to Tasmanian children up to the age of five years.

The Examiner report sparked a passionate campaign led by the Child Health Association of Tasmania (CHAT) to preserve CHAPS as an unchanged, universal service.

CHAT spokeswoman Christine Minchin said the department guaranteed to continue the service during a February 28 meeting with DHHS, a guarantee that has been confirmed by director of nursing Christine Long.

However Minchin said CHAT would continue its campaign, as there remained a number of unanswered questions about the proposed changes including: the number of standard checks that would be undertaken over the course of a child’s growth; the program’s increasing reliance on mainstream health services; and the meaning of its emphasis on “vulnerable families”.

Long said the number of visits on the universal schedule [currently at 10 for Tasmanian children under five years old] would be reviewed “so we can put a greater focus on helping the families, especially the children, missing out”.

The DHHS said no child would be turned away from the reformed CHAPS service, but that “those parents assessed as motivated and capable of addressing emerging parenting issues without support will be encouraged to make use of mainstream health and community services”.

Minchin said there was as yet no clarity on how this assessment would take place, though she had been told it would be in consultation with CHAPS nurses.

She said regular checks by child health nurses were vital for all families, because any family could be “vulnerable” at any time, regardless of education or socioeconomic position.

“Parents might not always see something right in front of their eyes, or the child might compensate for a problem. That’s why there are specialist nurses,” she said.

Ellis told Nursing Review the DHHS plan constituted a move to rely more heavily on mainstream health services for the health care needs of Tasmanian children.

She said the department had stopped replacing nurses on sick or annual leave, and had enacted a policy to not employ casual child health nurses.

This had led directly to the cancellation of appointments and new mothers’ groups, she said.

“The rationale behind the new positions about not employing casuals was directly around budget cuts,” Ellis said.

The DHHS strongly denied claims the changes to CHAPS were part of an ongoing bid to slash the Tasmanian health budget, and told Nursing Review there had been no reduction in funding to the program.

Forward estimates project around $127 million in cuts will be made to the Tasmanian health budget in the next financial year, with the $25 million shortfall from this year’s goal of $100 million in savings being rolled over into the next.

Minchin said the support Tasmanians had shown for the service since the Examiner story should make the state’s child health nurses very proud.

“The mums that are speaking are all volunteers and members of the community, and we’ve had story after story … [such as] if it hadn’t been for [CHAPS] my child wouldn’t have been diagnosed with autism, or I wouldn’t even be here at this point [due to postnatal depression].”