Mr. Peter Tyndall:

The Senator is fundamentally correct, there is little point in producing reports of this kind unless there is a follow through and that the recommendations are implemented. From my perspective, leadership at a clinical and an administrative level within the health services is where the fundamental change needs to happen. It needs to happen in a way that attends to the culture on individual wards in hospitals. There are issues about physical infrastructure that can be put in place in order that people have a separate space in the time leading up to the death and also to be with their loved one after death. There are elements which can be put in place and one can recommend that every acute hospital put them in place, but more of these elements relate to the culture of care on the ward and the way clinicians are trained in the initial training and also as they go forward. The advantage of the hospice friendly hospital programme being in place is that one can point to a template for how to things well. The report should lend impetus to that piece of work, on which we will continue to work with the Irish Hospice Foundation. I too commend it for its work on this issue and also for the work it has done, as the Senator says, to bring the issue to the attention of many more individuals, clinicians and managers. Hospitals need to have a strategy in place on how they deal with end of life cases. In terms of a follow-up, we have in a sense commended a template to it. We have put forward examples of how not to do things, but we can see what complaints are coming in and look at whether hospitals are implementing best practice set out both in this report and the report of the Joint Committee on Health and Children and the work of the Irish Hospice Foundation.

There is a strange ambiguity about Irish attitudes to death. The traditions around it made it much more real and personal. The majority of people now die in hospital and the numbers are striking. Each day 35 people die in an acute hospital in Ireland and this, in a sense, has moved it out of communities and away from people's experience to something that happens elsewhere. It is particularly important that it be dealt with well. In that sense, we will continue to work with the Irish Hospice Foundation. We will also work with the HSE to ensure it is driving the issue forward. We will support the recommendations that there be a strategy and an individual responsible for the strategy in place in each acute hospital setting. We will then monitor change through the number of complaints received. If we continue to receive complaints, that will give us much more leverage to actually say it is not good enough and that the hospital should have been implementing the findings and that we want it to do so as a consequence of the investigation or examination we have undertaken.