Public health: Thousands of children across the State are not getting their nine-month developmental check-ups on time as a result of a shortage of public health doctors.
In one area alone there have been no nine-month developmental checks on babies since 2003.
As a result, opportunities to pick up developmental problems early are being lost.
There are now 2,000 children awaiting developmental checks in one region.
The shortage of public health doctors working in the community, otherwise known as area medical officers, isn't just having an adverse effect on children. It is also affecting the elderly, who are now waiting months in some areas to be assessed for certain allowances.
In one area, according to Dr Paula Gilvarry, chairwoman of the national public health doctors committee of the Irish Medical Organisation, people are waiting for assessment for allowances since May 2004.
She would not identify the areas where waiting times were longest as she said the problem was nationwide.
Public health doctors working in all areas went on strike for several weeks in 2003. "We were in crisis before the strike in 2003 because we were short doctors . . . the deal we got was that we would have 150 in the community . . . at the moment we have less than 130 and it could be as few as 110," Dr Gilvarry said.
As a result, work is piling up. "If you are an adult, you will wait but if you are a child, you miss out on an important screening test if a developmental check is missed. Early intervention could be missed as a result," she said.
"At present, we are very understaffed - most community care areas are at half capacity. Meanwhile, the population of 0-4-year-olds has increased considerably since 1996 and the number of elderly is increasing, especially those over 85 years. So we have more patients to see and less doctors," she added.
Explaining the work of area medical officers, she said they were "the keep-you-well rather than the make-you-well doctors". They are the doctors who examine children in schools and give immunisations, check the growth and development of babies at nine months, give advice and preventive antibiotics when meningitis is detected in a school or community, assess families for entitlement to allowances for a child who needs extra care and attention or an adult whose disability prevents them from using public transport. They also inspect private nursing homes as part of a team and watch out for the vulnerable elderly in the community.
"The health service is obliged to offer these services free of charge to the community.
"How can we deliver all this if we are reducing in numbers? The answer is we cannot and we are struggling, children are missing developmental checks, mobility allowances are piling up, all our work is delayed. So why is no one shouting? Well, we work with children, the elderly, those socially excluded, those with disability. These groups do not shout loud," she said.
She said the IMO was due to meet the Minister for Health Mary Harney at the end of this month about public health out-of- hours cover and hoped to raise the "major manpower crisis" with her.
A spokesman for the HSE said it recognised there was a shortage of public health doctors in the community. He said there had historically been difficulties recruiting doctors into the community health sector.
Nonetheless, the HSE was, he said, making every effort to fill vacancies as they arose and was working with the medical organisations on a reorganisation of community medical services and on how best to use the resources which were available.