Gerry Horkan (Fianna Fail) | Oireachtas source

It will be hard to try to follow that. I congratulate Senator Marie-Louise O'Donnell; it is a fantastic publication. It is not my area of expertise normally, but I am delighted to be asked to speak on behalf of my colleague. It is a very fine 256-page report. I cannot say I have read every page and all the details, but I have read and absorbed a considerable amount of it. As it happens, my mother lectured in UCD for many years in social science. She lectured in gerontology, elder abuse and many of those areas over her 33 years in that department. Therefore, I have a bit more exposure to this topic than many people might think I do.

I welcome the opportunity to speak on the report. I support every aspect of it that I have read. I congratulate the Minister and wish her well in her new role. I also congratulate Senator Marie-Louise O’Donnell on the report which examines how the State and Departments - with the exception of the Department of Health which understandably is being dealt with in a different way - support people who are facing dying, death and bereavement. As an accountant, one might say there is nothing more certain than death and taxes. Unfortunately it comes to us all.

The report illustrates that dying and death cannot be looked at in isolation or as primarily the remit of one Department and that those facing death or those who have been bereaved will often encounter the Department of Social Protection and the Revenue Commissioners, but also many other Departments. We must therefore recognise that the State plays a role in dying and bereavement and how it responds can greatly affect individuals' and families’ experience at what is a difficult and sensitive time.

More than 30,000 deaths were registered in 2016 and almost 30,000 in 2015. This comprises people of all ages and people who died from multiple causes - natural, accidental, suicide and illness. For example, 151 neonatal deaths of children under four weeks were registered in 2015. Diseases of the circulatory system accounted for 9,249 deaths, almost one third of the total.

While these are not easy or comfortable subjects to discuss, the report underscores that we will all face dying and bereavement and we need to start a conversation about end of life. By doing so, the State will be better equipped to respond holistically and with compassion to the challenges associated with dying, death and bereavement.

The recommendations of this report, including the need for the State to develop a whole-of-Government strategy on end-of-life care, a review of income supports and allowances, and also developing quality standards for bereavement, should be acted upon.

We must face the reality that dying, death and bereavement come to us all and as the report encourages us to do, we must think and plan ahead for the inevitable.

The report examined the work of Departments in supporting citizens at end of life and in bereavement. The Department of Health was doing its own review and was excluded. Fifteen Departments along with the OPW and the Office of the Revenue Commissioners were part of this research. Based on the findings of the research, the report makes a number of overarching recommendations, as well as recommendations for each Department. Some of these have been covered already but it is worth highlighting them again.

These recommendations include developing an integrated strategy on dying, death and bereavement for Ireland. This is the primary recommendation of the report. Such a strategy should be wider than health care and extend across the spectrum. In order to conduct a national dialogue on end-of-life issues, the report recommends the State should engage in a consultation and listening exercise to inform the new strategy. The report recommends that the State conduct a socioeconomic review of costs linked to end of life, not as a cost saving exercise, but to determine the most appropriate, effective and efficient services for the dying, the dead and the bereaved. As Senator Marie-Louise O'Donnell said, most people would prefer to die in the community, in their homes with their families where possible, rather than in a nursing home or a hospital.

The report proposed the development of a dedicated website on end-of-life services offered by the State, providing a comprehensive outline of all State services that are available to support people at the end of life. It is essential that people are able to access comprehensive, accurate and up-to-date information on the relevant supports and services offered by each Department.

The report recommended that each Department review its services from an end-of-life perspective and develop a plan of action including a bereavement policy. This review should include ensuring that front-line staff receive training in communications. Each Department should also develop a bereavement policy and a range of supports for its own staff.

To reduce the administrative burden the report recommended developing a "call us once" service and a bereavement service helpline. The "call us once" service that operates in the UK allows a person to make a phone call on the death of a loved one and this information is disseminated to most affected Departments. The report recommends that a similar system should be considered in Ireland. That would be a very simple process when set up. It would relieve much of the burden.

I helped out an elderly neighbour of mine whose husband had died. People are required to go through an amount of organisations and agencies, and it is very upsetting to get letters and polling cards. If someone dies outside the State, the death certificate does not get to the places it would reach for those who die in Ireland. They remain on registers and continue to get letters sent to them which can be quite distressing even though it is understandable that it happens.

The report recommends the Government should review the income supports available to people who are bereaved, including an analysis of the telephone allowance, fuel allowance and living-alone allowance. We have discussed things. I understand the pressure the Minister is and will be under as we approach budget time. The telephone allowance did not cost much and gave people certainty. Equally with the fuel allowance, people are far more worried about fuel than many other things.With the amount of extra cost involved, the Minister could give a lot of people peace of mind.

The report also recommends that we support people to live and die in the community. It is important to ensure that the supports and services are in place allowing those at the end of life to have access to multidisciplinary teams of professionals within their own communities. It is recommended that the bereavement grant be reinstated. For many people, this was a very important grant at a very difficult time. It helped meet some of the financial costs that follow in the aftermath of a death. Funerals and the simple process of burial are extremely expensive, most of all in Dublin but also across the country. It is a huge burden for many families. The report recommends that we adopt the Think Ahead planning tool and encourage people to plan ahead. Developed by the Irish Hospice Association, Think Ahead allows people to make preparations for their future care and to put their affairs in order. The report argues that the State should adopt this tool and make it available to every citizen free of charge.

The report recommends that the Government should use its global influence to support the development of palliative care services internationally into the future. It recommends the development of quality standards for bereavement. There is currently no statutory policy or standard in respect of bereavement services in Ireland for adults or children. The report recommends that the State should ensure that all bereavement supports, including counselling, provide a consistently high standard of service. There is a recommendation to set up a working group in the Department of Education and Skills to develop guidelines and education programmes for teachers - involving civil society and teachers - to examine ways in which to support grieving children. Government Departments and agencies must recognise their role in these matters. The report challenges the State to build dying and death into policy and practice across all Departments and agencies. Whether death is sudden or prolonged and whether the person involved is young or old, it is at this time that we most need to be treated with courtesy and civility by the State and to feel that we have been so treated.

I congratulate Senator Marie-Louise O'Donnell and the big team behind her. I recognise a number of their names of those involved, for example, Jane Lehane, Denis Murphy, who was in college at the same time as me and is now the principal of St. Mary's, Ita Mangan, who lives in my former electoral area, Seamus Boland, whom I have met before, and John O'Keeffe. I did not even know all these people were involved in producing the report until I began reading it. I commend the report to the House. It is a fantastic publication and I hope many of its recommendations will be implemented sooner rather than later. Well done.