New report evaluates palliative and hospice care in Ireland

Investment in end-of-life care has made Ireland a world leader in advancing palliative and hospice care but regional inequities persist, according to an evaluation report just published by the Dean of Health Sciences at Trinity College Dublin, Professor Mary McCarron and colleagues at the School of Nursing and Midwifery. The Trinity report examined The Atlantic Philanthropies funded 'End of Life programme' – which aimed to improve the care and quality of life for patients dying from an incurable illness and to ensure they and their families received excellent end-of-life care and services. 

The programme was carried out by several organisations including Milford Care Centre, Limerick; the Irish Foundation; Marymount Hospice; the All-Ireland Institute for Hospice and Palliative Care and the Irish Association for Palliative Care.

A 2004 survey conducted by the Irish Hospice Foundation found that too few people near death in Ireland were receiving appropriate hospice and palliative care. For example, more than 60% of all deaths in Ireland each year took place in acute hospitals yet less than 25% of the country's large hospitals had a full specialist team dedicated to palliative care.  It also found that nearly half of Ireland's counties had no inpatient hospice units and few non- who were dying had access to hospice treatment. These findings came despite a 2001 Irish government policy to provide universal palliative care to everyone in need. 

The  'End of Life' programme which received  €25 million in funding  from Atlantic commenced in 2004 and its main aims were:

  • Improving services for hospice patients in hospitals, in-patient hospice settings and at home by both specialist palliative care professionals and generalists such as nurses and doctors. 
  • Supporting education and research activities including training workers and clinicians in best practices.
  • Funding accreditation and advocacy efforts including supporting the establishment of standards and monitoring.
The findings

The Trinity report just published found that the programme had considerable success in expanding and improving the provision of end-of-life care including: 

  • Increased access to care in all settings following investment in services in hospice, hospital and at home. For example the Marymount Hospice, a new in-patient hospice facility, doubled the number of hospice beds—from 24 to 44—in Cork County and serves as the specialist hub for palliative care services in Cork and surrounding areas.  
  • Increased awareness of hospice and palliative care nationally, among both patients and healthcare professionals. The Hospice-Friendly Hospitals programme, which works to ensure that end-of-life care is central to hospital practice, trained nearly 3,000 staff to improve palliative care for patients and families. It operates in 80 per cent of acute hospitals. The programme also produced "Quality Standards for End-of-Life Care," which highlight 18 ways in which hospitals can advance end-of-life care.
  • Increased access to care for non-cancer patients.  A Hospice at Home Service, the first of its kind in the Republic of Ireland, made a commitment to extend care to patients with conditions other than cancer. Operated by the Milford Care Centre, the project reported that non-cancer referrals increased from 13 per cent in 2008 to 30 per cent in 2010.
  • Increased education programmes spanning basic to specialist levels of palliative care. 
  • Establishment of the first of its kind All-Ireland Institute for Hospice and Palliative Care, with a mandate to strengthen research, training, standards and policy influence. The only one of its kind in the world, the All-Ireland Institute for Hospice and Palliative Care is a consortium of eight health agencies and four universities. One key outcome is improved collaboration between palliative care and the wider heath sector. 
Challenges

The Trinity evaluation also found that there were a number of  challenges remaining in the hospice/palliative care field in Ireland:

  • The End of Life programme has increased capacity in regions that previously had few hospice resources but has not fully addressed geographical inequities.
  • Poor communication between specialist palliative care provision and end-of-life care provided by generalists is a continuing issue.
  • There has been insufficient statutory support to implement comprehensive specialist palliative care provision in low-resource regions.
Commenting on the significance of the findings, Professor McCarron said: "At a time when there is so much focus on the challenges to be faced in healthcare this report highlights tremendous achievement in the expansion of availability and quality in . Nevertheless it also highlights some of the challenges still to be faced including some remaining regional inequities. Even in an environment of more restrained resources a roadway is provided on where next steps should occur."

More information: Link to full report:
www.atlanticphilanthropies.org… ireland-final-report

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