Ms Caroline Thomas:

I reiterate that we are a charity and are the only providers of hands-on paediatric nursing care in Ireland. The case Ms Moran referred to was in Wicklow approximately one and a half months ago. The child left Crumlin hospital without a medical card so between Crumlin hospital and ourselves we provided the child with the equipment needed for a week. That is the reality on the ground. Crumlin hospital and Jack and Jill provided the equipment to feed that child through a nasogastric tube. The public health nurse could do nothing because she cannot apply for the equipment until she has a medical card number. Our service is for children under the age of four.

That comes back to the education issue, as Ms Ling and Dr. O'Reilly said. The GP who was linked in and whom I spoke to when I was on call asked me why I was feeding the child. That is the child's most basic need. The last thing one would do would be to stop feeding a child. People are not exposed to these cases and they do not understand.

I recently had a case in Malahide of little boy who went home with a life-limiting condition and had Jack and Jill respite for a month. He did not need a home-care package and subsequently he returned to Temple Street Hospital because his condition had deteriorated. He was unable to go home because he needed maximum nursing care. While he was waiting for a home-care package he died in Temple Street Hospital, not in accordance with the wishes of his parents who wanted to take him home. We could not provide enough support because our maximum is 64 hours per month.

Subsequently that mother wrote to The Irish Times about another child who had been sitting in Temple Street Hospital awaiting a home-care package for over a year, and two days later her package was sanctioned. That case was in County Offaly. That is the reality. Everybody is talking about the medical card but, unfortunately, that is the reality.