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INMO Launches Report On Missed Care In The Community. 04.04.16
Press Release

Monday, April 4, 2016
-         The report recommends the establishment of a Commission to examine and develop all aspects of primary care services
The Irish Nurses and Midwives Organisation (INMO) today launched a report on Missed Care – Community Nursing in Ireland by Dr Amanda Phelan and Ms Sandra McCarthy, of the School of Nursing, Midwifery and Health Sciences, UCD. The report was commissioned by the INMO as part of our professional programme and strategy to develop community services in Ireland.
This new report, with its extensive research, from the School of Nursing, Midwifery and Health Systems, University College Dublin indicates that community nursing in Ireland is under severe strain.  The report lead author, Dr Amanda Phelan, points to the lack of necessary reform in community nursing which has led to a service which is struggling to meet the demands from challenges including a changing national demographic, earlier acute care discharges, more complex case management and moratorium consequences.
The report focuses on the concept of missed care which is where care that should have been done has been omitted, delayed or rationed either in part or wholly.  The study findings are based on surveys with 283 public health nurses and community registered nurses, interviews with stakeholders and a health economics review.  The findings include:

  •  Over 50% of respondents indicated missed care in their previous working week;
  •  17% indicated they had a caseload over a geographic population of 10,000;
  •  The main area of missed care was in health promotion, particularly in relation to older people and chronic disease management;
  •  Care of older people on the risk register was identified as a particular challenge – over 70% said they were unable to address this in the previous week;
  •  There was a high degree of missed care where caseloads included disadvantaged groups (asylum seekers, homeless, migrants and traveller populations);
  •  79% indicated they were unable to update case notes as required in the previous week;
  •  Lack of administrative support and inadequate staffing levels had a significant impact on missed care in the previous week;
  •  Increased caseload and case complexity also contributed to missed care; and,
  • It estimated that missed care in health promotion of an older person could have an individual cost of €18,527

Speaking at the launch Dr Phelan said:
“This study examines the context of community nursing (Public Health Nurses and Community Registered General Nurses) in Ireland.  Despite many reports pointing to the need for service reform since 1975, community nursing in Ireland has remained static in terms of demographic change, policy change and structural change within health services delivery. 
The experiences of the community nurses demonstrate that they are prioritizing clinical work (injections, dressings) and legislation obligations (child notifications and child protection) and although missed care was identified at lower rates in these domains, this was at the expense of health promotion and disease prevention.  However, in applying case scenarios based on cost benefit analysis of addressing health promotion areas in a comprehensive way, clear potential economic savings can be made. “  

  • According to the report the consequences of missed care are multifold: 
  • A lack of human capital to meet community population need; 
  • Reduced ability to alleviate the pressure on acute care; 
  • A lack of ability to provide choice in care in community; 
  • An inability to meet statutory and regulatory expectations; 
  • A potential increase in health costs due to missed care; and,
  • Staff burnout and missed care has been identified with a higher level of intention to leave.

One of the main recommendations emanating from the study is that a Commission be established, to report within one year, to determine the roles that nursing/midwifery will play as a central component of any developed primary care system.
Speaking today, INMO General Secretary Liam Doran said:
“The results of this study again reinforce the need for sustained investment in our public health service.  The lack of proper funding has severely hindered nurses and midwives in the delivery of care as is evidenced in the study.  A fit for purpose primary care service is an essential component of any health service and it is vital that investment is made now and into the future to ensure that a world class service can be delivered to all those who need it.
 Dr Phelan concluded:
“Urgent reform is required in terms of ensuring comprehensive care is delivered by a community nursing workforce that can adequately contribute to contemporary health demands at primary, secondary and tertiary care levels for individuals, families and communities.”


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