Policy analysis: palliative care in Ireland.
Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the 'policy analysis triangle' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation.
School of Nursing and Midwifery, Trinity College Dublin, D'Olier Street, Dublin 2, Ireland. Electronic address: mayp2@tcd.ie.
Peter
P
May
School of Nursing and Midwifery, Trinity College Dublin, D'Olier Street, Dublin 2, Ireland. Electronic address: hynesge@tcd.ie.
Geralyn
G
Hynes
School of Nursing and Midwifery, Trinity College Dublin, D'Olier Street, Dublin 2, Ireland; School of Social Welfare, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY 12222, United States. Electronic address: pmccallion@albany.edu.
Philip
P
McCallion
School of Nursing and Midwifery, Trinity College Dublin, D'Olier Street, Dublin 2, Ireland; International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Boland Tower South, Lancaster University, Lancaster LA1 4YT, United Kingdom. Electronic address: s.a.payne@lancaster.ac.uk.
Sheila
S
Payne
School of Nursing, Midwifery and Health Systems, UCD Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland. Electronic address: philip.larkin@ucd.ie.
Philip
P
Larkin
School of Nursing and Midwifery, Trinity College Dublin, D'Olier Street, Dublin 2, Ireland. Electronic address: mccarrm@tcd.ie.
Mary
M
McCarron
D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D010166:Palliative Care / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D011050:Policy Making
Health policy; Hospices; Ireland; Palliative care; Policy making; Terminal care