Marie Louise O'Donnell (Independent) | Oireachtas source

I thank our guests for their presentations on this tough subject. I will address three short questions to Dr. Gregan. In what ways could general practitioners, GPs, be supported to enhance their delivery of palliative care? How could the Irish College of General Practitioners play a role? His submission mentioned the issue of medical cards for people with terminal illnesses and limited prognoses. Will he expand on the importance of that provision? What problems has he encountered when such people need to renew their cards?

I thank Ms Burke for her presentation. I will cite the Minister for Health. I am not a member of this committee, but I am interested in this subject and have been following it as a broadcaster, a writer and a Senator. On 23 May, the Minister, Deputy Reilly, told the committee:

My final point, which deserves to be made repeatedly, relates to the tendency in nursing homes in the past to refer patients who are dying to hospital emergency departments ... The tendency to transfer gravely ill residents to emergency departments seems to arise out of concerns and perhaps a lack of confidence in dealing with the terminally ill patient. It is a dreadful tragedy and affliction for such people that the last hours of their life are spent in unfamiliar surroundings. It is utterly inappropriate. To address that issue, the Health Service Executive has begun, through its clinical programmes, sending specialist gerontologists out to nursing homes to support them in dealing with these situations, which are emotionally difficult for all concerned. It is not in the interest of patients who are coming to the end of their days ... They should be allowed to see out their time [that is an interesting term] in the facilities that have become their homes while receiving all the proper care and attention they require.

Are people inappropriately transferred from their homes in long-stay nursing homes to accident and emergency departments? If so, what could be done to help staff to prevent this practice in addition to the clinical programme mentioned by the Minister? When a resident dies in a nursing home, how does it cope with supporting other residents and staff?

I thank Ms Tan of the Institute of Community Health Nursing, ICHN. She stated that due cognisance should be given to the role of the public health nursing service across the disease trajectory, including end of life, alongside the specialist palliative care service. Will she expand on this point and what further supports would be required from her colleagues who provide specialist palliative care to have the central role of the public health nurse in end of life care recognised?