Every week the technical group has a chance to ask priority questions to one government minister. This week Stephen had the opportunity to put a question to the Minister for Health and Children which he used to raise the topic of palliative and end of life care.
Stephen Donnelly: To ask the Minister for Health and Children his plans, including investment, targets and timelines, for the reform of palliative and end of life care, in order that persons are afforded the dignity and respect they deserve and receive appropriate, high quality care in an environment of their choosing.
The response was delivered by Kathleen Lynch, the Minister of State for Disability, Equality and Mental Health.
Kathleen Lynch: Palliative care services are delivered by the Health Service Executive, in partnership with voluntary organisations. The overall budget provision for these care services in 2011 is €74 million.
My immediate aim is to ensure that the priorities, targets and time lines for palliative care, as detailed in the agreed HSE Service Plan 2011, are achieved as intended by the end of this year. These include the delivery of specialist palliative care services to almost 3,600 people each month in 2011; promoting care at end of life projects through the design and dignity grants scheme. The purpose of this scheme is to develop a range of exemplar or demonstration projects within a hospital, region or sector which will guide future development relating to end of life issues; progressing phase 1 of the palliative care policy for children with life limiting conditions in Ireland. Ultimately, this policy aims to ensure that all children with these conditions will have the choice and opportunity to be cared for at home. It recommends the appointment of a consultant paediatrician with a special interest in paediatric palliative care and eight outreach nurses – a successful candidate has been identified for the consultant post and will take up duty shortly; and implementing the minimum data set for palliative care. This is designed to provide better information on all patients availing of specialist palliative care services to further improve the planning and delivery of services.
I also intend that the various capital projects agreed under the HSE service plan for this year will be progressed. These include completion of the projects at Marymount Hospice, Cork and St. Ita’s, Newcastlewest, in addition to minor capital works at local level. Palliative care and end of life issues will continue to be developed within the overall continuum of care services and within the context of the current budgetary and fiscal climate.
As is customary, Stephen was then able to pose two further question to the minister:
I thank the Minister of State for that response. We have some examples of good practice, for example in Limerick and in the mid-west where we have the 30 hospice beds and the multidisciplinary teams. The target is one hospice bed for every 10,000 of population. Three regions have that, two are at 40%, two are at 30% and three regions have none, not a single bed. Wicklow, the area I know best, has no beds although it is part of a different region. The home care team has four nurses, one of whom is on maternity leave and another on sick leave, but because of the recruitment freeze, those positions cannot be filled, even temporarily. Therefore, Wicklow has only two nurses for the whole area. I suggest to the Minister that the issue is one of variance and would like to know what is being done about that. For example, where we have best practice – in Limerick – the State spend is €30 per head, but in Wicklow the spend is €3 per head. What is being done to provide best practice around the country?
Kathleen Lynch: Deputy Kelleher will know we have been extraordinarily well served in Cork with the hospice movement there. On the question of the gaps that exist, a palliative care service medium-term development framework was published by the HSE in July 2009. This sets national priorities which have been agreed by all stakeholders, based on solid needs analysis, to ensure that services do not develop in an ad hoc fashion and that any developments proposed in future reflect areas of greatest need. This methodology ensures an equitable approach to service provision, as well as consistency of inputs, such as pay and non-pay costs and staffing levels. I take on board the Deputy’s comments. No matter where people are, their needs are the same and we must ensure an equitable delivery of the service.
Stephen Donnelly: I have the 2009 plan here and agree it is a good plan. I suggest the HSE is the problem and that it is a managerial problem. For example, in Wicklow there is co-funding of €3 million for a €6 million hospice and an ongoing operational expenditure is proposed of €2.5 million. We know this is provided at a cost saving and that in terms of the economics, it saves us significant money. As the Minister pointed out, we are now in a Fianna Fáil-induced IMF world and must try to save money. While I am delighted the HSE report has been made and bought into by the stakeholders, the people within the hospice world to whom I have been talking say there is no transparency within the HSE. In Wicklow, for example, there has been a local buy-in to the plan, but it disappears into the morass of the HSE. Can anything be done about that organisation, which does not appear to be reacting to its own plan, specifically in an area which could save us significant money and provide better health care to people all over the country?
Kathleen Lynch: The Deputy has asked some relevant questions. We cannot, for the very reasons the Deputy has asked the question, have a county by county, or regional approach to this. We must pull it together and have a national service. The national steering group on palliative care is the way to go. This is chaired by the HSE, but driving out the plan will ensure we have a more equitable approach throughout the country. I hear the Deputy’s concerns.