Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

I thank Deputy Wallace for raising this issue. Motor neurone disease is a complex and challenging condition. The diagnosis, treatment and care of individuals with motor neurone disease requires input from a wide variety of services, ranging from GP and community services through to acute hospital and specialist disability services.

I understand that the individual at the centre of this case has complex needs. I am familiar with the case raised by the Deputy. The HSE has advised me that numerous multidisciplinary meetings have taken place to try to ensure appropriate care for Mrs. Lynch-Rowe. She is currently receiving continuous positive airway pressure therapy at night time provided by HSE community services. The HSE is continuing to explore all options for this patient's future care. The HSE remains available at all times to discuss these issues directly with the individual and her family.

The HSE advises that the question of whether a patient can access home ventilation therapy, whether invasive or non-invasive, is not purely a financial issue but must be considered across a number of dimensions, including: First, a proper discharge care plan, which is discussed between the hospital consultant team and the appropriate primary or community care team, needs to be agreed and activated to ensure the appropriate set-up is in place and can be sustained to meet the care needs of the patient over time; home ventilation needs appropriate equipment, trained staff and both patient and family education as well as arrangements for the upkeep and maintenance of such ventilation equipment; nurses supervising such patients at home need to be appropriately qualified and competent to supervise the patient clinically; and, a commitment to provide the necessary financial resources to support the care arrangement into the future.

As I mentioned earlier, the patient is currently using non-invasive ventilation therapy in the home and I understand that there is currently no clinical indication for full mechanical ventilation in this case. However, the HSE has advised that this case will be kept under review and should a requirement for invasive home ventilation therapy be identified for this patient in the future this matter will be considered by the relevant hospital and community services.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

I confirm that the HSE is available at all times to discuss the issues directly with the individual concerned and her family. I am assured that is the case.

I agree with the Deputy that there are complex issues involved. In deference to the individual concerned I wish to move away from the case that has been raised because Deputy Wallace is touching on the broader ethical question of how such decisions are made in terms of cost. I agree with him that such issues are enormously difficult and complex, ethically and otherwise. They deserve a lot more debate in society and perhaps in this House. We should try to find a context where we would debate that.

To return to the individual situation under discussion, it is not the case that it is reducible to the question of cost. As I indicated, there are a number of different factors and according to the expert medical opinion available to me and the HSE I am advised that there is no clinical indication for full mechanical ventilation in this case. That having been said, I do not wish for a moment to indicate to the Deputy that I am in any sense dismissive of the issue he raised. I am aware of the particular case. The HSE will discuss the issues directly with the individual concerned and her family but in these circumstances it would be wrong to draw the conclusion that this is in any way reducible simply to the question of cost because there are clinical considerations as well.