Professor Doiminic Ó Brannagáin:

I thank the Chairman and committee members for the opportunity to address them today. My colleague, Dr. Tony O’Brien, in introducing the report of the National Advisory Committee on Palliative Care in 2001, wrote "As a society, perhaps the most sensitive measurement of our maturity is the manner in which we care for those who are facing the ultimate challenge - the loss of life". It is timely, therefore, 12 years on from the adoption of this report as Government policy, that the Joint Committee on Health and Children should revisit this subject. I sat in this room five years ago, the last time the joint committee considered the matter, and the deliberations were extremely helpful and productive in bringing about significant change. I lend my support to the deliberations on this occasion on this vital topic. I do not propose to read from my script because of time limitations but I will concentrate on three key messages. These are the health benefits of palliative care; "upstreaming" of palliative care; and the importance of integration of palliative care.

Dame Cicely Saunders, who is credited with the modern hospice movement, wrote:

I once asked a man who knew he was dying what he needed above all in those who were caring for him. He said, "For someone to look as if they are trying to understand me".

Palliative medicine, the science that informs specialist palliative care, attempts to do this. In accompanying patients and their families to a place where few clinicians are comfortable, we have developed a body of medical science and expertise demonstrating unequivocal evidence in advanced cancer and emerging evidence in heart failure, chronic obstructive pulmonary disease, renal failure and certain neurological conditions. We can produce improved symptom management in patients, quality of life, decision making with regard to patients' choices of care, as well as decreased caregiver burden and increased length of life, as evidenced in recent studies on advanced cancer. If this was a pharmacological or surgical intervention, we would have people clamouring on the streets to get it. Nevertheless, the reality is that people do not truly understand the health benefits of palliative care. In the north east we have undertaken a piece of research on patients who are actively receiving palliative care and their families. Many of them did not understand the words and language we used, and it was only when bereaved family and caregivers had concluded the care that they truly understood the benefits that could be achieved for loved ones.

Upstreaming is the incorporation of palliative care into standard care approaches to life-limiting illness. We should draw on the expertise we have seen delivered very successfully in Ireland through the National Cancer Control Programme, with specialist palliative care now forming an integral part of the planning process of treatment for patients. We should seek to incorporate that into other approaches for life-limiting illnesses.

Drawing on my experience, in the north east we have two acute hospital-based teams and three community-based teams. Our service is placed predominantly in the hospital in the first instance and we have shown that we can both detect patients with life-limiting illness earlier and offer them choice, as Senator Crown noted in his earlier comments. By this we can influence the policy on palliative care within acute hospitals to the benefit of all patients. In the 12 years our service has existed in Our Lady of Lourdes Hospital in Drogheda, the number of referrals of patients with a non-cancer diagnosis has increased to 40%. Most importantly, we can influence and have an input into the care management of patients on a seven-day basis, including out of hours.

A third point refers to integration. In most cases, when people speak about specialist palliative care and integration, they refer to the integration of the palliative care services, which are integrated seamlessly from one element to another, including hospice care, care in acute hospitals, care in the community and education and research services provided. This enables navigation of the patient from one care setting to another, to the benefit of the patient. However, when I refer to integration I am talking about the challenge facing palliative care services in terms of integration into existing health care provision models. When Dame Cicely Saunders initially set up the modern hospice movement, she felt she had to move from the existing acute hospital structure in order to develop the model of hospice care. Her ultimate aim was to mainstream the process into acute hospital care. The next challenge for palliative care services is to see us do this, and there are many benefits both to patients and to the efficiency and effectiveness of specialist palliative care services in delivering that.