Dr. Karen Ryan:

The lack of such a facility is certainly one of the key factors that limit us when we are making such a calculation at present. Additional infrastructure would be necessary to facilitate its development. If this is done, one of the main limitations will be overcome. We know from Our Lady's Hospice and St. Francis Hospice, which are the two service providers in Dublin, that 80% of our referrals originate in acute hospital settings. The majority of the care we provide to them is provided in their own homes in the community setting. If I recollect the figures from the minimum data set correctly, approximately 8,000 new patients would have received community palliative care services over the course of a year. Approximately 2,000 patients would have been admitted to an inpatient unit, perhaps for two or three weeks before returning home again.

I was asked what I would prioritise in terms of improving community palliative care provision. The staffing issue is a critical one. We need to address the deficiencies in community clinical nurse specialists and, importantly, the allied health professionals within the team. The education of other general palliative care practitioners in the community would also support improved care in the community.

A question was asked about the range and depth of palliative care services in acute hospitals. We have specialist palliative care teams in all model 4, model 3 and - potentially - model 2 hospitals. If one examines the actual staffing ratios of those teams, one will find that they are usually markedly sub-optimal. In many cases, there is no more than a sessional commitment on the part of the consultant to the acute hospital setting, the team consists predominantly of clinical nurse specialists, there are low staffing ratios and very few allied health professionals are attached to the specialist palliative care team.