John Gilroy (Labour) | Oireachtas source

I welcome the Minister to the House. I assure Senator Marie-Louise O'Donnell that this morning when we saw the amendment proposed by the Government, we were equally concerned and, as Labour Party Senators, made our concerns known to the Minister, who agreed to withdraw the amendment. We were shocked that the amendment would have come before the House in the first place and we are happy to support the motion.

Last year the Joint Committee on Health and Children conducted public consultations in the area of palliative care, end-of-life care and bereavement. The contributions to the committee find good expression in the motion before the House. That is the reason we welcome it. I commend Senator Marie-Louise O'Donnell on tabling the motion. It is part of a political process and it is good practice, if a motion is introduced in one House of the Oireachtas, that we follow it up here later.

Last month I presented a report to the Joint Committee on Health and Children on suicide prevention which I hope we will be able to progress here. The Minister is aware of and is supportive of it and will surely come in to discuss it with us. During the public hearings we heard from a range of expert witnesses, including the Institute of Community Health Nursing. Public health nurses have a key role to play in this area because, in conjunction with general practitioners, they are probably the first ones who come upon the need for palliative care. That is how it should be. There is a huge role for public health nurses, which needs to be expanded. We need to support them in the delivery of care as close as possible to home in the community. The care needs to be structured and holistic, and public health nurses are to the forefront in this area.

Nursing Homes Ireland also made a thoughtful contribution, pointing to the fact that 23,000 people receive residential care in our nursing home services. Some 75% of the care is provided by the private sector, which has a role to play also. I draw attention to several publications in this area and one in particular which was written in conjunction with the Irish Hospice Association, End-of-Life Care for Older People in Acute and Long-Stay Care Settings in Ireland. It is an excellent document which provides a platform on which to build our strategies, and should be used as one pillar of a comprehensive and holistic approach that is needed in this area. Who better to listen to than the experts delivering the services? That points to the comprehensive nature of Senator Marie-Louise O'Donnell's motion and the reason we should support it. The motion is non-controversial and eminently sensible in calling for a comprehensive and strategic view of how we might deliver services. There is no question that the services are very good, but they could be better. A strategic view of services is exactly what is needed. I am aware that the Minister is keen that this is the way it should be.

To speak about the importance of delivering palliative care and end-of-life care as close as possible to the person's home is not to ignore the increasingly complex nature of some of the palliative care interventions required. Unfortunately, their complexity means it will not be possible for some people to receive palliative care treatment in the location of their choice - that is, at home or in a nursing home - as it may require complicated intervention at acute level.

Where it is possible to ensure that palliative treatment is provided in the home, we should do everything possible to support that.

Declan Walsh, a professor of palliative care medicine, made a contribution to the committee also and called for a comprehensive, integrated, palliative medical programme. When professors of palliative care call for this, they are obviously saying we do not have it currently. We need - and the Minister is looking at this - to provide a service that is closely linked with clinical, operational, financial and administrative services.

I had reason in the past couple of weeks to have some contact with accident and emergency services in this country, one in Navan and the second contact with Cork University Hospital, in regard to the admission, on an acute basis, of two very unwell elderly people. The service provided in these accident and emergency services was far from optimum and I was very discouraged by the level of treatment received by both of these people. Whether this was an unfortunate or isolated instance or symptomatic of something worse in our accident and emergency services, it needs further examination.

I abhor hearing the media talk about elderly people as "bed blockers". I have heard the Minister say many times here that what is needed in this country as much as resources and staffing is a change in the culture of how we deliver services. I know he is strong on that and look forward to working closely with him in that area. I have a lot more to say, but do not have the time to say it now .