The minister reacts after it emerges that some terminally ill people are not allowed to die at home due to staff shortages

The Minister for the Elderly has said it is unacceptable that palliative care cannot be provided for some terminally ill patients at the “most vulnerable point of their dying days”.

ary Butler said she was concerned by news from her Waterford constituency that some terminally ill patients are currently unable to receive end-of-life care due to a “staffing crisis”, as detailed in an internal memo reported today.

Ms Butler said the crisis is affecting palliative care for people who wish to die at home in Waterford and South Kilkenny as a number of staff are absent due to coronavirus and other illnesses, leading to a shortage of palliative care staff.

“Many older people wish to die at home and it is absolutely essential that all care and support can be given to the most vulnerable in their dying days,” she said Independent.ie.

HSE officials held a meeting today to discuss the situation after the news broke. Ms Butler said the shortage was affecting HSE staff providing day and night home care in the community, adding that a separate palliative care service at Waterford University Hospital was unaffected.

Employees at the university hospital have been informed in recent days that the palliative care team can only accept referrals from “patients who are actively dying”.

The HSE confirmed there is a temporary shortage of specialist nurses within the care team which arose nine days ago and which it believes will be addressed within the next week.

Sinn Féin health spokesman David Culliane – also a Waterford TD – said it needed “absolute coordination” between the hospital and regional HSE management to deliver the service. “Noody can sit back and wait for things to return to normal next week as patients are turned away [from getting care]it needs to be all hands on deck to ensure all services resume,” he said.

Ms Butler said when there were staffing shortages in care homes at the height of the pandemic, there was greater coordination.

“I believe this is a time of crisis where if someone dies and needs palliative care, we need to look at some kind of service level agreement that can provide support,” she said.

She said she will raise the issue with Health Secretary Stephen Donnelly, who is responsible for palliative care, adding that her counterpart in government recently invested €10m in the sector, along with €200,000 in Waterford.

The original internal email sent to UHW staff apologized for the sudden drop in service.

“Due to the staffing crisis at the Waterford Community Palliative Care Service, we can only accept referrals for actively dying patients,” it said.

“I am very aware that we are still actively dealing with Covid,” Ms Butler said.

“We still have a long way to go in terms of Covid and we need to be aware of that. We still have many employees who are sick because of Covid and we are still fighting this pandemic, especially in healthcare.

“But we must ensure that the most vulnerable get the support they need in their dying days.”

She added that Waterford currently has the highest 14-day incidence rate of PCR-confirmed cases of just over 650 per 100,000 residents after positive county tests.

Patients cared for by different medical departments may be referred to the palliative care team upon diagnosis of a terminal illness.

According to the HSE, palliative care can be provided “at any stage” of a person’s illness and need not be provided at the end of a person’s life.

End-of-life care can often begin several months before a person’s death. However, according to medical sources, “active dying” may only refer to a handful of days before a person dies.

The email’s author then instructed recipients to contact specific employees directly to discuss recommendations. “We apologize for this change in our service and I will be in touch with you once this crisis is averted,” they wrote.

A spokeswoman for HSE South East Community Healthcare (SECH) said the group “regrets to announce that due to “unforeseen and unavoidable” circumstances, the Waterford palliative care team has experienced a temporary reduction in specialist nursing staff.”

She added: “Services within this team are expected to return to normal levels within the next week. In the meantime, access to the services will be prioritized based on clinical needs.

“All available supports and services are and will continue to be offered to patients and their families.”

She said palliative care advice and support for healthcare professionals remains available to help manage palliative care patients outside of the acute hospital setting.