Seanad debates
Thursday, 15 June 2023
Nithe i dtosach suíonna - Commencement Matters
Health Services
9:30 am
John McGahon (Fine Gael)
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I thank the Minister of State for coming to the House to discuss the very important issue of palliative care services in the north east of Ireland, which is where I come from. I am raising this issue today because of a real discrepancy in the services that are being provided in the CHO region - not compared to the rest of Ireland but in the region itself. It concerns the difference between the services provided in Louth and Meath and those provided in Laois and Offaly, which are in CHO 8.
Many specialist palliative care, SPC, teams are similar in structure. They have a team of clinical nurse specialists and three consultants in palliative care medicine. In the summer of 2022, one consultant said on local north-east radio that there would be a waiting list for palliative care services in the north east as a result of increased challenges after the pandemic - a waiting list for terminally ill patients. Patients requiring palliative care have already gone through so many treatments and hospital appointments. They have done literally everything to have an extra day on this earth. Regarding the cancer strategy that was announced in 2017, we guarantee as a right that people will have the ability to die in their own home, own bedroom and own bed. There are people in my county of Louth and my neighbouring county of Meath who are not being given that choice and as a result, are dying in hospital and acute settings, rather than where they want to be.
The reason for that is quite simple. Again, I will focus on CHO 8 in my neighbouring area. In Cavan and Monaghan, with the exception of Louth and Meath, public health nurse services are operational in the management of symptom and pain management and have the skills to administer the syringe treatments and ensure that all patients are being seen in their place of residence as opposed to a hospital. To be clear, in the CHO 8 area, in Laois and Offaly, nurses are able to go into homes and administer pain relief medicine. However, this is not the case in Louth and Meath. Nurses there are not allowed to do that. Instead they are getting the nurses above them - the specialist clinics - to do that but there is a shortage of those specialist clinics. This is not a case of a supply issue or a staff shortage. To be honest, the end-of-life treatment you get is almost a lottery based on your geographical location. If you are in Louth and Meath, we will not send in public health nurses to give pain relief medicine such as injections, syringe-based treatments and palliative care. We are, however, doing it in Laois, Offaly, Cavan and Monaghan, as well as other parts of the country. There is a discrepancy and I do not understand why this is happening. I have example after example of people in my county of Louth dying in hospitals because they were unable to die at home, which was their last wish, because staffing arrangements in the HSE are different in Louth and Meath compared with Laois, Offaly, Cavan or Monaghan. It is upsetting to say the least that this is happening. For as long as I am a Member of this House, I will continue to fight for people in my county of Louth and my town of Dundalk have the same right of access to palliative care as that of people in other parts of the country. It is down to a staffing decision in the HSE. Why on earth is a nurse able to give palliative care treatment in Laois or Offaly but nurses are not allowed to do so in Louth or Meath? It does not make sense.
I appreciate the Minister of State coming in here and that I am throwing a lot at her that she might not have known about before coming in here. Perhaps after this debate, either through the offices of the Minister of State or the Department of Health, we could set up a meeting between myself and CHO 8 in the Louth-Meath area to see how we could fix this.
Anne Rabbitte (Galway East, Fianna Fail)
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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.
John McGahon (Fine Gael)
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That is very promising. As always when the Minister of State comes to this House, she has come with a fair and balanced view. I greatly appreciate the outcome she outlined. What is needed is a fundamental review of the services in Louth and Meath with a view to finding out why they are different from elsewhere.
To be clear for the record, in Laois, Cavan and Monaghan, public health nurses provide that pain management, whereas in Louth and Meath, it is still managed by clinical nurse specialists, who are a tier above that. Why is that happening? Why do people have to return to a hospital to die, rather than have a public health nurse administer palliative and end-of-life treatment? It is deeply upsetting for the many people who have to go through this. People want to die at home, surrounded by their friends, family and loved ones. They want to die in an area where they are comfortable. As part of the cancer strategy, we have to provide that for everyone, but there is a clear discrepancy whereby people in my county, Louth, and my town, Dundalk, are being severely discriminated against compared with people living across the county border in Cavan, Monaghan and elsewhere in CHO 8. I would appreciate if that discrepancy were rectified.
Anne Rabbitte (Galway East, Fianna Fail)
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I again thank the Senator for raising this issue. Due to its urgency, I will ask my office to liaise with that of the Minister to get it set up straight away. I would hate to think we did not have public health nurses throughout Louth and Meath, so we must address how the practice is delivered there. We will address that over the coming days.
Martin Conway (Fine Gael)
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I thank the Senator for raising that important issue.