Pearse Doherty (Sinn Fein)

Cuirim fáilte roimh an rún seo. Is maith an rud é go bhfuil an t-ábhar seo á phlé againn ar ár gcéad lá ar ais sa téarma seo. Molaim an Seanadóir Mullen fá choinne an rún seo a chur chun tosaigh ar son an ghrúpa Neamhspleách. I welcome and fully support the motion. It is a very important issue. It is interesting that we are discussing end-of-life care in hospitals as the Dáil has just finished discussing the end of life for the Government. While the Government intends during the debate in the Dáil to increase its lifespan until April, when it indicates the by-elections will take place, it is apt that we are discussing the same theme in both Houses today, although this one is much more serious than the pending elections.

The motion refers to the audit of end-of-life care in hospitals published last May by the Irish Hospice Foundation, which does excellent work and needs to be commended in this House. The audit found that one in five acute hospital patients could have died at home if enough supports had been provided for them. It is one of the greatest scandals of our health system and our social services that far too little has been done to provide the necessary supports for older people in particular to live and die in their own homes, if that is their wish, instead of in nursing homes or hospitals. We now find that the improvements that have been made are beginning to be cut back.

Prominent in the news this week is an issue that affects my own region, namely, the savage impending cuts to the health service in the vast HSE west region which stretches from Limerick to north Tipperary to my own home county of Donegal. We heard in the news yesterday SIPTU addressing the cutbacks that are happening in County Mayo in home help services. The union described the cuts as brutal and said that €500 million is being withdrawn from home help services in that county alone. I disclosed in the House not only this year but last year the cuts taking place in my home county of Donegal where 78,000 hours of home help support have been stripped away this year. This is support that helps people who have taken the decision to stay at home to die because that is their wish. The type of cuts to which I refer in Mayo and Donegal is reflected across the other regions.

Is é ceann de na polasaithe is lochtach, is salach agus is tromchúiseach atá ag an Rialtais ná an cinneadh ciorraithe a ghearradh ar dhaoine atá ag deireadh a saoil agus ag lorg tacaíocht ón Stát. Thóg na daoine sin an tír seo. Bhí siad anseo le linn an Chéad Cogadh Domhanda agus an Dara Cogadh Domhanda. Bhí ar cuid acu imeacht ó baile, dul ag obair thar sáile agus airgead a sheoladh ar ais go dtí an teaghlach chun tacaíocht a thabhairt don chlann agus don phobal. Níl an Stát ag tabhairt aon tacaíocht dóibh, agus iad ag deireadh a saoil, chun cuidiú lena gcinnithe bás a fháil ina gceantracha dhúchais, bailte agus teaghlaigh fhéin a chur i bhfeidhm.

The measures proposed in this motion should have been undertaken over the past decade when the Government was boasting about the health of its public finances. We now know it squandered those finances and created the economic crisis we are faced with. It is the old, the infirm, the sick, the disadvantaged and the marginalised who are paying for the crisis, not the people who caused it.

It is a false economy because the savage cuts are taking billions out of the economy and depressing it further. The Government has operated the same type of false economy with regard to health care and social services rather than providing the supports for terminally ill people to remain at home in their communities or in hospice care. Government neglect means that their lives end in acute hospital wards that are often overcrowded, which is distressing for themselves and their families and loved ones. It lacks the dignity and comfort which could be theirs in more appropriate settings.

If we want to consider this in purely economic terms, which is not the way we should measure it but the way the Government seems to consider everything these days, it is far less cost effective in the long term. The Irish Hospice Foundation audit identified significant weaknesses in how the hospital system responds at each stage of the patient journey from admission to death. There are variations not only between hospitals, specialties and wards but also within them. There is also variation in what is called the quality of dying in hospitals, with the experience depending on the patient's disease. It is surprising that most hospital staff receive little or no preparation for the death of patients. It is not surprising, only sad and tragic, that the poorest experience was for the patients with dementia or frailty. According to this report, in the case of sudden deaths, one third of relatives do not seem to be informed as to the reason for post mortem examinations.

These are small but distressing elements that could be rectified simply. The Government should accept this motion and, more importantly, act by implementing the quality standards in end-of-life care in hospitals without delay.

Gabhaim buíochas leis an Seanadóir Mullen as an rún seo agus an am seo a ghlacadh leis an cheist fíor-thábhachtach seo a phlé sa Seanad.