Securing a "Good Death" in an Irish Hospital

Denis Doherty

Issue 392, vol.98, Winter 2009

Despite the advances in medical technology, the hospital always has a duty of care to those who are beyond cure : almost 25% of UK hospital-beds are still occupied by patients in the last year of life.

Not that death in hospital is most people’s first choice. A 2004 survey here by the Irish Hospice Foundation, found that two-thirds of people wanted to die at home – and only 10% expressed a preference for a hospital setting. But in practice, 70% of us are dying away from our own homes – and 40% of that figure in busy acute hospitals.

Only 15% of beds in our acute hospitals –and 14% in community hospitals – are in single rooms (with most being used for infection control). The professional recommendation is that 50% of beds should be in private rooms. Only single-room, ensuite accommodation will allow family and friends to be with the dying person without intruding on other patients (and will allow space for spouse or partner to rest). As things stand, people are dying in open wards, with no privacy other than a flimsy curtain around the bed (which is sometimes as little as 13 inches away from an adjacent bed). They may be forced to use a commode beside them. Their private conversation with family and care workers can be overheard – and they can be subjected to the sound of television and laughter from the other side of the curtain.

Mortuaries are often in poor condition; and only 42% of our acute hospitals and 16% of community hospitals have a bereavement service.

A study of 300 acute care and long-stay facilities across the State (undertaken by the social gerontology centre at NUI Galway) found that most staff had no formal qualification in palliative care – and that routine visiting-service provision from geriatricians, public health nurses, social workers and other professionals was very low. Staff could be found [1999 Irish research] talking over or around the patient rather than to them. The (more recent) research discovered that staff shortages sometimes prevented care being person-centred, individualised and based on resident choice. A first step towards improving matters would be to institute a review-procedure to take place between doctors and family following a patient’s death.

According to the chair of the National Council On Ageing And Older People, the NUI Galway study-findings suggest that neglect of end-of-life care for older people is indicative of ageist attitudes in our society : the eradication of such ageism must be a primary concern for the country’s leaders.

There is a role for an independent advocate in assisting some older people to make a decision about their care and treatment. But ultimately a “public health”-campaign approach is called for – where palliative care services would engage with schools and workplaces, and where the public would be educated about what to expect when grieving, and how to support the bereaved in their community…Death is a time requiring solidarity (which, of course, is not to forget sanctuary also).

Denis Doherty is a management consultant in healthcare and the Chairman of the Irish Hospice Foundation. He worked in the Irish health service from 1971 and 2005. From 1980 to 2002 he was CEO of the Midland Health Board and between 1988 and 1997 he served as CEO of the Mid Western Health Board.

In 1997, he set up and directed the Office for Health Management (OHM) and in 2002 he was asked by the health boards to set up and direct the Health Boards Executive (HeBE). Denis Doherty is a former member of Comhairle na nOspideal and served a three-year term as President of the Standing Committee of the Hospitals of the European Union. In addition to the IHF, he is chair of the Simon Communities of Ireland and President of the Health Management Institute of Ireland.