Speech by Minister Brady at the Inaugural Meeting of the Community Hospital’s Network – Quality at End-of-Life

25 November 2009

I am delighted to be here this morning to speak at this inaugural meeting of the Community Hospital’s Network. I would like to thank Mervyn Taylor and Aoife O’Neill from the Hospice Friendly Hospitals Programme for their kind invitation to speak today. I would like to thank Mary Bowen – Special Projects Manager – for all her hard work in making today happen and Tim Dalton who will Chair the Community Hospital’s Network. I would also like to thank Graham Knowles CEO of the Royal Hospital who very generously agreed to host this meeting.

Despite the fact that most people would wish to die at home, over 20,000 people die annually in Ireland, in hospitals of one sort or another and 40% die in acute hospitals. Historically and culturally, hospitals are perceived as a place where people go to get ‘cured’ of their illness. Unfortunately, sometimes this is not possible due to the nature of the illness. The historic focus on ‘cure’ has meant that end-of-life care has not necessarily been an identified core activity of hospitals and this has been reflected in its absence from service plans, systems, culture and structures.

This significant gap was identified in the Report ‘End-of-Life Care for Older People in Acute and Long-Stay Care Settings in Ireland’ which was commissioned jointly by the National Council on Ageing and Older People and the Irish Hospice Foundation. The Report highlighted the need for policy reform to ensure that end-of-life care is recognised as an important public health issue separate to Palliative Care but inclusive of many of its key elements.

Draft Quality Standards for End-of-Life Care in Hospitals

The Hospice Friendly Hospitals (HfH) Programme - a five year national Programme initiated by the Irish Hospice Foundation, in partnership with the HSE - aims to ensure that the physical environment of hospital facilities are sensitive to end-of-life care, providing privacy, choice and dignity. This Programme is supported by Atlantic Philanthropies, the Dormant Accounts Fund and the Health Services National Partnership Forum.

Under the Hospice Friendly Hospitals Programme, Draft Quality Standards for End-of-Life Care in Hospitals have been developed. These Draft Standards set out what a person at end of life and their family can reasonably expect from hospitals in terms of service provision, support and quality of care. It also sets out how training and supports for hospital staff should be delivered and how hospital systems should function to ensure that the best possible care is delivered in a co-ordinated manner to patients to enhance their end-of-life care.

The Standards outline four basic principles: patient care, support for families, staff training and support, and an integrated hospital approach. The Standards also reflect key aspects of the end-of-life process in hospitals – safety, sanctuary and solidarity.

Currently, under the health Act 2007, the Health Information and Quality Authority (HIQA) has the statutory remit to develop National Standards for health and social care and for monitoring their implementation. At present, there are no specific legal Standards relating to end-of-life care in acute and community unit environments. However as you know my colleague Minister Harney approved National Quality Standards for nursing homes earlier this year. I am confident these Standards will ensure the protection of residents’, they will safeguard and promote their health, welfare and quality of life. In particular, Standard 16 provides for End of Life Care. It states that each resident continues to receive care at the end of their life which meets his or her physical, emotional, social and spiritual needs and respects the resident’s dignity and autonomy. We have underpinned this Standard with Regulations that came into force on 1 July, 2009.

In addition, HIQA intend to draw up National Standards which will be linked to a mandatory licensing system for both public and private healthcare providers. The National Standards for Quality and Safety will be informed by externally developed National guidelines such as those produced by the Hospice Friendly Hospitals Programme.

A ‘Good Death’ – Making Plans.

In all of us, there is an understandable reluctance to face death and this can be a significant barrier when we consider end-of-life issues. “Thinking and talking about death need not be morbid; it may be quite the opposite. Ignorance and fear of death overshadow life, while knowing and accepting death erases this shadow” (Lily Pincus, author of Death and the Family: Importance of Mourning). The Hospice Friendly Hospital Programme has done much to raise people’s awareness of end-of-life issues and to encourage people to start considering what a ‘good death’ for them might mean. “A good death is one that is appropriate for that person...It is a death that one might choose if it were realistically possible for one to choose one’s own death” (Shneidman, Edwin PHD, ’Criteria For a Good Death’, pg. 245). Knowing the person’s wishes for end-of-life care, enables family members, care givers and staff to ensure that the person’s wishes are respected.

The Establishment of a Community Hospital Network

The need for a Community Hospital Network in the greater Dublin area was identified through the valuable work of the Hospice Friendly Hospital’s Programme. This innovative and important development is to be commended. Community Hospitals face a wide range of challenges in the provision of end-of-life care and becoming part of this Network will provide valuable support and advice as solutions are found to these challenges.

Being a part of this Network, which will improve communication and collaboration between Community Hospitals / Long-Stay facilities, specialist palliative care providers, Acute Hospitals and primary/community care services, will result in the fostering of meaningful and long term partnerships. These partnerships, by their very nature, will result in the sharing of expertise, knowledge and resources, which will impact positively on the quality of life of the patients at end-of-life. Being part of this Network can only lead to better outcomes for both the patient and staff going forward.

Conclusion

I think we all acknowledge the growing demand that will be placed on palliative and end-of-life care going into the future. I firmly believe that today, it is more important than ever to combine our respective expertise and knowledge as we plan for the challenges of the future.

We must work together, to share our insights and expertise, with a view to developing and improving end of life care services, in an efficient and effective manner and in an atmosphere of mutual support, respect and understanding. The Community Hospital’s Network is a perfect example of how, when we work together, we can learn, share and grow, improving services for both staff and patients alike.

I would like to congratulate all those involved in the Hospice Friendly Hospital’s Programme for doing so much to highlight the issue of end-of-life care and for establishing this Community Hospital’s Network which will prove an invaluable source of support, advice and training for staff into the future.

Given the opportunity, we would all chose to be involved in decisions about our end-of-life care. It is at this crucial time in our lives that the feelings of isolation and grief could become overwhelming but the thoughts of a pain-free peaceful death might enable us to accept our changing circumstances and face our final moments without fear. I sincerely believe that we all deserve a ‘good death’ surrounded by loved ones, our wishes respected and our dignity preserved.

I would like to leave you with a quote from Ester Rantzen, which I feel captures what we must strive to achieve for each and every patient who is at the end of their life and that is a ‘good death’. “I have learned that no one can escape the pain of bereavement, but a good death can become the ultimate celebration of a good life” .

Thank you.