Professor Susan O'Reilly:

I do not want to interrupt. I wish to focus on a second element of the Senator’s comments relating to the gaps that might exist in care. Ireland has good consultant palliative care but there are some gaps in the midlands and in the north east in particular, which are being addressed. The consultant palliative care that is provided in the acute hospitals and hospices is excellent. In addition, there is a new palliative care report, which has not been issued yet, that we strongly endorse should be implemented. We are also aware that in the community, there is a recent €240 million being invested through the Department of Health and the HSE in enhanced community networks. These are usually GP led but they provide a level of care for seniors and people with chronic diseases, and they are capable of providing an element of primary and community palliative care.

We must put that front and centre because nearly three quarters of people would like to die at home but only 23% of people do so for a variety of reasons. It may be symptoms but it could also be that families are not able to support them or they do not have access to the 24-7 coverage they would like to have for either an urgent GP visit or possibly 24-7 access to pain medications that people might want. There are good efforts going on already to try to address this. I have some statistics that I will not necessarily go through in the interest of time but these enhanced networks are rolling out across the country. I endorse that and the home help component of this as well, where often recruitment of staff, training and maintenance is more of a challenge than actually finding the money to do it in order to give people the care packages they need to stay at home.

It is important that to consider, as committee members look at the recommendations, where they need to put their emphasis. We in the Irish Hospice Foundation believe that everybody deserves a good death. They deserve access to equitable resources across the country. Palliative care is crucial and patients can avail of this. Whether or not this committee rules in favour of proposing legislation, we would hope that would be an option to add on and not replace palliative care.

It should never do that. I certainly feel reasonably optimistic, based on experiences elsewhere, that investment in palliative care will continue to grow and not be reduced as a consequence of any potential future legislation. That remains uncertain, but it is important that not only are there supports in the community and in palliative care, but that there are supports for patients so they feel they will be treated with dignity, listened to and talked to. We have a think ahead package, which assists people to understand how to have a dialogue with professionals and their families. There is the Act that empowers people to make an advanced care directive can help them as they go forward into the future.