Phil Prendergast (Labour)

I join others in commending Senator Mullen on this timely motion, which calls on the Government to develop measures to allow people to die in their homes rather than in hospitals and to allocate resources in order that more people can access comprehensive hospice services in their community. With regard to this model, it is a case of one size fits all and there should not be inequities in the home care packages provided in various parts of the country. Currently, there are regional inequalities in the services available to people. The regional deficits, according to the Irish Hospital Foundation's review of staff and bed numbers in specialised palliative care in Ireland, released in June 2008, revealed continued and major shortages of hundreds of vital staff and beds across the country. A study on staffing levels in specialised palliative care in 2007 found that patient and family access to comprehensive services was still largely dependent on the region of the country in which the patient lived and Exchequer spending on care staff and specialist palliative care inpatient unit beds varied from €790 per capita in the former South Eastern Health Board area comprising Waterford, Wexford, Kilkenny, Carlow and south Tipperary to €35 per capita in the former North Western Health Board area covering Donegal, Sligo and Leitrim. There was a great discrepancy in what was provided and in the services available.

This is a sensitive subject, which will face every one of us, as there is no avoiding it. Many valid issues were raised by previous speakers but it will be important to invest in palliative care in future. More than 6,000 people currently use hospice services every year and it is estimated up to 13,000 patients will require access to palliative care. Many hospitals are sensitive to the needs of patients and families where a death is expected and if it is possible, an attempt is made to meet their needs by transferring the patient to a unit where there is not as much traffic and which is less public, although this is terribly difficult. I worked in hospitals for many years and they all had a bereavement room or an area where people could go to have a cup of tea and meet staff members who had palliative care training. It is vital to be able to deal with the different emotions experienced by immediate family members, which can be very much dependent on the age of the patient. If somebody has lived to a good age, the loss is not lessened because the longer one has with somebody, the more likely it is that the or she has played a large part in one's life and one will miss him or her.

However, one of my saddest experiences during my training was when I worked in the paediatric unit. At the time the treatments for cystic fibrosis were not as good as they are today and depending on the severity of a child's condition, one could estimate his or her life expectancy when he or she was going downhill, as he or she reached various milestones through his or her response or non-response to treatment. I found it desperately difficult as a student nurse encountering that for the first time. When I became a mother, I realised how much greater such a loss was. I do not say women who are not mothers could not experience loss but having been a student nurse, a staff nurse and a midwife and undergoing training to deal with those who suffered loss there was an expectation that it was a normal part of life and we had to undergo further bereavement training. Senator Mullen has called for that.

Training and upskilling involves a cost, even if only in terms of time. Many nursing and hospice staff undergo training at their own expense because it is not something the HSE is expected to cover. However, there should be a comprehensive support programme for everyone involved, whether they are staff giving the service, patients or family members and family support systems need to be put in place to deal with issues relating to end-of-life care. We should not be found wanting in this regard. The Irish are famous for how they say goodbye to the people they love. The wake has long been considered a good send off. The best send off that can be given to people is to give them their dignity and the choice about how they want to end their lives. Where a patient is suffering, he or she should be provided with adequate pain relief and palliative care should meet all his or her needs. Where the need for pain relief can interfere with quality of life, a call must be made. For example, a decision on whether a patient should be resuscitated should be made on clinical need in consultation with the family. It is difficult because the decision can sometimes be about turning off a switch. These are highly charged, emotional issues and there is usually an element of suffering. Most people want to see an end to suffering and patients should not be left in accident and emergency departments where there is hustle and bustle and other people are coming in need of acute care or as hot admissions, as they might need to be resuscitated or to be sent for surgery.

One of the difficulties in some areas of the country is it is preferable to send a patient from a nursing home to an accident and emergency department because of the system. If the person was left in the nursing home, it would mean dealing with autopsies and paperwork. Sometimes it is preferable to send these people to a hospital. This is less than ideal for someone who has been a client of the nursing home.

I am glad to have the opportunity to make a contribution and I again thank Senator Mullen for his timely motion. I thank the Minister of State for her attention.