Dr. Maeve O'Reilly:

With regard to maternity leave, the consultant paediatrician is on maternity leave and has not been replaced. Dr. Twomey and I provide the service. We have 1.5 whole-time equivalents in Crumlin awe lost half a post when our last nurse went and was not replaced. She is due to go on maternity leave next February and as of the last meeting there will not be a replacement for her. This certainly influences what happens, not only in the case of palliative care. It happens everywhere.

I am conscious that I did not answer some of the questions put at the beginning about the upskilling of staff because it is the way to go. The people concerned already have generic skills and just need to be upskilled. It would be a more cost-effective way of doing it. To be fair to the HSE which we have been bashing a little, we have had positive developments. An education programme was started in Crumlin in response to the needs assessment of 2005. It was also pump primed by the Irish Hospice Foundation, but my understanding is that the HSE is now funding it. We provide education at two levels. We organise study days throughout the country which are attended by GPs and public health nurses when we deliver talks on general palliative care and symptom control. These are well attended and well evaluated. We also provide level two training in Crumlin. It is one thing to provide education, but one must be able to release staff to attend, which is another critical issue. We are very lucky that the three nurses who work with us in Crumlin are highly trained and have masters degrees. They are superb nurses but getting funding for them to undertake a masters degree course is like negotiating the Good Friday Agreement and takes forever. We are lucky to receive donations from the public and families and try to ring-fence this money. It goes into the general pot, but we try to keep it to one side in order that we can educate our staff. Much is done in the staff's own time; it is not done within working hours. These are constraints. We have been speaking about upskilling and considering getting some of the LauraLynn staff who are excellent in providing respite care but who perhaps do not have much experience in providing end-of-life care to work in adult hospices for a short period or to come to us in Crumlin. The goodwill is there and it is not a problem; it is just a question of practicalities in getting staff released.