Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I thank the Senator for bringing such a valuable contribution to the floor of the Seanad. I compliment the Leader of the Seanad on accepting it because I was totally unaware of the discrepancy. I will read the script prepared by the Minister, Deputy Donnelly, and then I will give an answer. The Minister for Health has been advised that SPC services in Louth and Meath provide care to patients of all ages irrespective of diagnosis, cancer or non-cancer, on the basis of need alone. These services are provided by a multidisciplinary team, including consultants, clinical nurse specialists and a range of health and social care professionals. Patients may be referred at any stage of illness, in some cases from the time of diagnosis.

The HSE has informed the Minister that all patients are triaged in line with national policy. Consideration is given to the reason for referral, the patient's underlying diagnosis, his or her symptom burden, and how acutely unwell he or she may be. Triage usually occurs on the same working day as referral, or in some cases the following day. The HSE has stated that it is unusual that triage wait times would be longer than two days. The HSE has informed the Minister that the percentage of patients triaged within one working day in Louth has increased from 51% in 2020 to an estimated 81% in 2023. The triaging of patients categorises their needs, in a formalised way, on the basis of this information. The patients may be categorised as U1, to be seen within 48 hours; U2, within seven days; or U3, within 14 days. These categories have been determined nationally - this is the national policy on triaging. The triage process can be short-circuited by a simple phone call from the GP for any patient who is deemed to be at the end of life or imminently dying.These patients will be seen ordinarily on the same working day, Monday to Friday. New referrals over the weekend are dealt with on the next working day. The Minister has been advised that referral rates have increased for both Louth and Meath since 2020. The first assessment of all patients is ordinarily taken by a clinical nurse specialist or, in some cases, depending on the complexities, may be undertaken by the consultant. In line with the HSE policy on digital health, some first assessments are undertaken virtually. The decision regarding a virtual or face-to-face assessment is made on the basis of information in the referral and informed by discussions with the primary referring GP or hospital consultant. Should it become apparent an assessment is required face to face, it is usually done on the same or next working day.

I do not think the Minister, to be fair to him and his team, had a clear understanding of the issue the Senator laid out. The prepared reply with which I was provided relates to the national policy, the timelines and how assessments are administered, but the Senator is asking about what happens when persons are discharged to their home and pointing out that the approach to the right to end-of-life care provided to them in their home is very different from how it is done in Laois and Offaly or Cavan and Monaghan. It is not in keeping with the practice in the rest of the CHO. There seems to be a higher level of administrative inconvenience in Louth and Meath than in the other regions, where a public health nurse is able to address the issue. In Galway, the public health nurse is part and parcel of the process, as happened in the case of my own mum. I will hold a meeting, subject to securing the support of the Minister, with representatives of the Senator's CHO to have a clear understanding as to why there is not equity of access to public health nurses for all patients at a palliative care level throughout the Senator's CHO.