The Knock That Didn't Come

AI-generated illustration. © Voices of Life.

MJ Gallagher was born in October 2023 by emergency caesarean at University Hospital Waterford.

There were worries about reduced movement. He needed help straight away and was moved to Cork University Hospital for cooling therapy.

At four months old, his parents, Clíodhna and Brian, got a diagnosis: cerebral palsy.

That's hard news for any mother and father to hear. But they've said the early diagnosis was a huge benefit. It meant MJ could start physiotherapy, occupational therapy and speech and language therapy early. It also meant someone sat down with his parents and showed them how to help him grow.

That's what early looks like. Someone notices, someone acts, and a family isn't left on its own.

Now hold that picture beside this week's other news.

On 3 November, the Ombudsman for Children published "Milestones Missed". It found that the HSE "failed to ensure the effective delivery of a universal health examination service to all children under the age of six."

Every baby in Ireland is meant to have five core contacts with a public health nurse. The first is a home visit within three days of coming home. Then come checks at three months, nine to 11 months, two years and four years.

In 2025, 85.8% of babies had their nine-to-11-month check before their first birthday. The Ombudsman estimates that nearly 7,700 babies may not have had it on time.

Seven thousand seven hundred.

That's not a statistic you can see. It's a kitchen with nobody at the door. It's a mother wondering if it's normal that her baby isn't sitting up yet, and having no one to ask.

The report is careful. A missed check doesn't mean a child has been harmed. But it can delay referrals, assessments and early help. That's exactly the help that made such a difference to the Gallaghers.

The Ombudsman was especially worried about children living in homeless and international protection accommodation. These children move often, and their records don't always follow them. The report calls this a "foreseeable risk" that developmental, welfare and child-protection concerns "may go unidentified."

Those are the children with the least, and they're the easiest to lose track of.

The cause isn't a secret. Since 2022, the HSE has sorted cases by urgency because there aren't enough public health nurses. The HSE told investigators that recruiting and keeping them has been a "serious national challenge" for years. The INMO says there are more than 300 vacancies, and that 20 places on the HSE's training scheme are unfilled.

To its credit, the HSE accepted the findings, called the prioritisation decisions regrettable, and promised a national oversight group. INMO general secretary Phil Ní Sheaghdha put it plainly: "They must back up their regret over missed care with the recruitment and further training of public health nurses."

So here's a question worth asking out loud. We spend a great deal of public breath on choice. How much do we spend on the child who has already arrived, and whose mother is waiting for a knock that doesn't come?

Being pro-life doesn't stop at birth. It's a nurse on the doorstep on day three. It's a weighing scale on the kitchen table at nine months. It's someone who notices.

The babies can't ring the HSE. They can't write to a TD. They can only grow, a little every day, and hope someone is watching.

Let's make sure someone is.