Frances Fitzgerald (Fine Gael)

I welcome the Minister of State to the House and thank Senator Mullen and his Independent colleagues for tabling this worthy motion for debate. I was interested in a study supported by the Irish Hospice Foundation. The foundation's website states: "[T]he study paints a picture of a general public that is not very comfortable with or informed about the processes of dying and death." That is interesting, because the stereotype is that we are good around death, based on our tradition of wakes and the fact that families get a lot of support from relations, neighbours and friends during a loss or bereavement. It is interesting that when people studied this, they concluded that the public was not that comfortable with death.

In so far as we are becoming comfortable with handling death and supporting families, there is no doubt the hospice movement has played a major role. It has pulled back the curtain on the subject and facilitated a high level of discussion, particularly about the report on the end-of-life audit which it published. The information it is making public is incredibly important and offers us a real challenge.

The motion, with its details of the type of action that needs to be taken, shows us that while we are on the way, we have a lot of work to do. It is a detailed Private Members' motion, which is somewhat unusual as we often have more general motions. It specifies the kind of action plan that is needed. The key questions are whether these actions will be supported by the Government, what kind of support they will get, what kind of budget there will be and whether it will be cut. What can be done by changing attitudes, helping people to work better together, and ensuring our hospitals are more sensitive than they are at present to the issues highlighted by the hospice movement over the years? That is an important question. There is the possibility, as the motion states, that more people would want to be at home while suffering from a serious illness and, if possible, when they are dying. Given the number of people who reach the end of their lives while in hospital, there is a need for much more sensitivity and for every hospital to apply as many resources and supports as possible, along the lines recommended by the Irish Hospice Foundation, to the treatment of those at the end-of-life stage. Perhaps all hospitals now have this in their mission statements.

Senator Mullen explained in detail what needs to happen. It is surprising that there is still a need, as stated in the motion, to "develop systems to enable effective gathering of data on deaths in hospitals" and "ensure ongoing auditing of end-of-life care and the introduction of a system for review of deaths in hospitals in which bereaved families can participate". This is good practice and would be very helpful to bereaved families. A full plan exists and what is needed now is the political will to implement it and an action plan to ensure it happens and that there is support for it from medical authorities, the Department, the HSE and all concerned with this area. I doubt there is a Member in the House who has not experienced the dedication, commitment and top quality care provided by the Irish Hospice Foundation in hospices to people we know. We have all heard the stories and about the fund-raising that takes place. The hospice movement is worthy of the highest level of support. The public appreciates the work the movement has done at an educational and practical level.

This motion is timely. At a time when discussion is dominated by economics, banks and fiscal policy and the country is grappling with these major issues, it is vital that one does not forget it is the role of Government and politicians to steer society and its values. The motion brings us into the area of the important values of quality of life and care. The moment of death is an opportunity for society to demonstrate explicitly and implicitly how it cares and comforts its citizens in their final period of time on Earth. One of the founders of the hospice movement in the United Kingdom, Dame Cicely Saunders, summed up the attitude that guides us in the care we provide when she commented:

You matter because you are. You matter till the last day of your life. We will do all we can, not only to help you die peacefully, but to live until you die.

This moving comment deeply touches all of us who read and understand its meaning.

We need to consider a number of other areas. A significant number of children suffer from life-limiting illnesses. I frequently meet the parents of some of these children in my work. This week I was with a family with a young daughter with a life-limiting illness who is not expected to live beyond the age of five. The quality of care this family, which is supported by the Jack and Jill Children's Foundation, receives is extraordinary. Approximately 1,400 children in Ireland live with a life-limiting illness and approximately 350 of these die each year. It is critical we also focus on hospice care for families with children in this situation. We need to be conscious of the many different levels of hospice care and support required for people and families.

Like with our health services, one of the key issues in regard to hospice care is how to ensure consistency and quality of care. It is clear from reports I have read that the level of service is uneven, although improving, and underdeveloped in some areas. The chairman of the hospice foundation said in a recent report that the recession is not a reason to stop working for good end-of-life care and that the people who now face death or will face death soon do not have time on their side. He went on to say that we need to develop shared responsibility with the State to reduce our reliance on voluntary funding. Like with many other organisations, it is critical to decide on the balance of funding to be raised through voluntary fund-raising and statutory support. This is not an easy question in the current situation but we must live up to our responsibility as much as we can in the months and years ahead. I look forward to hearing what the Minister has to say in response to the motion.